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Nuibe EH, Chambers ME, Reno‐Bernstein CM. Norepinephrine mediates heart block during severe hypoglycemia in male rats. Physiol Rep 2024; 12:e70010. [PMID: 39180176 PMCID: PMC11343722 DOI: 10.14814/phy2.70010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024] Open
Abstract
Hypoglycemia is common in people with type 1 diabetes. Sometimes, severe hypoglycemia can be fatal. The underlying mechanisms by which severe hypoglycemia can lead to death are unclear. The sympathetic nervous system is thought to be proarrhythmic. We hypothesized that norepinephrine is the main mediator of severe hypoglycemia-induced fatal cardiac arrhythmias. To test this hypothesis, adult, non-diabetic Sprague-Dawley rats were subjected to hyperinsulinemic-severe hypoglycemic clamps (3 h, 10-15 mg/dL) during two different experiments: (1) intracerebroventricular (ICV) norepinephrine (n = 26) or artificial cerebrospinal fluid (aCSF) (n = 20) infusion or (2) blockade of norepinephrine release by intraperitoneal reserpine (n = 20) or control (n = 29). In experiment 1, brain norepinephrine infusion during severe hypoglycemia led to a 2.5-fold increase in third-degree heart block and a 24% incidence of ST elevation compared to no ST elevation in aCSF controls. In experiment 2, reserpine successfully reduced plasma and cardiac norepinephrine levels. During severe hypoglycemia, reserpine completely prevented second and third-degree heart block and T wave increases, a marker of myocardial infarction, compared to controls. In conclusion, norepinephrine increases while reserpine, used to reduce norepinephrine nerve terminal release, reduces heart block and markers of myocardial infarction during severe hypoglycemia.
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Affiliation(s)
- Emily H. Nuibe
- Division of Endocrinology, Metabolism, and DiabetesUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Matthew E. Chambers
- Division of Endocrinology, Metabolism, and DiabetesUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Candace M. Reno‐Bernstein
- Division of Endocrinology, Metabolism, and DiabetesUniversity of Utah School of MedicineSalt Lake CityUtahUSA
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2
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Nikpendar M, Javanbakht M, Moosavian H, Sajjadi S, Nilipour Y, Moosavian T, Fazli M. Effect of recurrent severe insulin-induced hypoglycemia on the cognitive function and brain oxidative status in the rats. Diabetol Metab Syndr 2024; 16:161. [PMID: 39004753 PMCID: PMC11247731 DOI: 10.1186/s13098-024-01410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Episodes of recurrent or severe hypoglycemia can occur in patients with diabetes mellitus, insulinoma, neonatal hypoglycemia, and medication errors. However, little is known about the short-term and long-term effects of repeated episodes of acute severe hypoglycemia on the brain, particularly in relation to hippocampal damage and cognitive dysfunction. METHODS Thirty-six wistar rats were randomly assigned to either the experimental or control group. The rats were exposed to severe hypoglycemia, and assessments were conducted to evaluate oxidative stress in brain tissue, cognitive function using the Morris water maze test, as well as histopathology and immunohistochemistry studies. The clinical and histopathological evaluations were conducted in the short-term and long-term. RESULTS The mortality rate attributed to hypoglycemia was 34%, occurring either during hypoglycemia or within 24 h after induction. Out of the 14 rats monitored for 7 to 90 days following severe/recurrent hypoglycemia, all exhibited clinical symptoms, which mostly resolved within three days after the last hypoglycemic episode, except for three rats. Despite the decrease in catalase activity in the brain, the total antioxidant capacity following severe insulin-induced hypoglycemia increased. The histopathology findings revealed that the severity of the hippocampal damage was higher compared to the brain cortex 90 days after hypoglycemia. Memory impairments with neuron loss particularly pronounced in the dentate gyrus region of the hippocampus were observed in the rats with severe hypoglycemia. Additionally, there was an increase in reactive astrocytes indicated by GFAP immunoreactivity in the brain cortex and hippocampus. CONCLUSION Recurrent episodes of severe hypoglycemia can lead to high mortality rates, memory impairments, and severe histopathological changes in the brain. While many histopathological and clinical changes improved after three months, it seems that the vulnerability of the hippocampus and the development of sustained changes in the hippocampus were greater and more severe compared to the brain cortex following severe and recurrent hypoglycemia. Furthermore, it does not appear that oxidative stress plays a central role in neuronal damage following severe insulin-induced hypoglycemia. Further research is necessary to assess the consequences of repeated hypoglycemic episodes on sustained damage across various brain regions.
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Affiliation(s)
- Mahvash Nikpendar
- Brain and Spinal Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Clinical Science Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moosavian
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
| | - Sepideh Sajjadi
- Brain and Spinal Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Moosavian
- Pediatric Neurology Department, Loghman Hakim Hospital, Shahidbeheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Fazli
- Department of Biology, Faculty of Basic Science, Islamic Azad University, Tehran, Iran
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Rode MM, Boggust BA, Manggaard JM, Myers LA, Swanson KM, McCoy RG. Follow up care for adults with diabetes treated for severe hypoglycemia by emergency medical Services, 2013-2019. Diabetes Res Clin Pract 2024; 213:111741. [PMID: 38866184 DOI: 10.1016/j.diabres.2024.111741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/25/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
AIMS To capture the types and content of healthcare encounters following severe hypoglycemia requiring emergency medical services (EMS) and to correlate their features with subsequent risk of severe hypoglycemia. METHODS A retrospective cohort was obtained by linking data from a multi-state health system and an advanced life support ambulance service. This identified 1977 EMS calls by 1028 adults with diabetes experiencing hypoglycemia between 1/1/2013-12/31/2019. We evaluated the healthcare engagement over the following 7 days to identify rates of discussion of hypoglycemia, change of diabetes medications, glucagon prescribing, and referral for diabetes. RESULTS Rates of hypoglycemia discussion increased with escalating levels of care, from 11.5 % after EMS calls without emergency department (ED) transport or outpatient clinical encounters to 98 % among hospitalized patients with outpatient follow-up. EMS transport and outpatient follow-up were associated with significantly higher odds of discussion of hypoglycemia (OR 60 and OR 22.1, respectively). Interventions were not impacted by previous severe hypoglycemia within 30 days. Prescription of glucagon was rare among all patients. CONCLUSIONS Interventions to prevent recurrent hypoglycemia increase with escalating levels of care but remain inadequate and inconsistent with clinical guidelines. Greater attention is needed to ensure timely diabetes-related follow-up and treatment modification for patients experiencing severe hypoglycemia.
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Affiliation(s)
- Matthew M Rode
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905 United states
| | - Brett A Boggust
- Creighton University School of Medicine, Omaha NE 68178 United states
| | - Jennifer M Manggaard
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN United states
| | - Lucas A Myers
- Mayo Clinic Ambulance Service, Rochester, MN 55905 United states
| | - Kristi M Swanson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN United states
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN United states; Mayo Clinic Ambulance Service, Rochester, MN 55905 United states; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN United states; Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD United states; University of Maryland Institute for Health Computing, Bethesda, MD United states.
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Vergès B. Cardiovascular disease in type 1 diabetes, an underestimated danger: Epidemiological and pathophysiological data. Atherosclerosis 2024; 394:117158. [PMID: 37369617 DOI: 10.1016/j.atherosclerosis.2023.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Cardiovascular disease (CV) is a common complication of type 1 diabetes (T1D) and a leading cause of death. T1D patients are more likely to develop CV disease (CVD) early in life and show a reduction of life expectancy of at least 11 years. Patients with a young age of T1D onset have a substantially higher CV risk. The reasons for increased atherosclerosis in T1D patients are not entirely explained. In addition to the typical CV risk factors, long-term hyperglycemia has a significant impact by inducing oxidative stress, vascular inflammation, monocyte adhesion, arterial wall thickening and endothelial dysfunction. Additionally, CVD in T1D is also associated with nephropathy. However, CVD risk is still significantly increased in T1D patients, in good glycemic control without additional CV risk factors, indicating the involvement of supplementary potential factors. By increasing oxidative stress, vascular inflammation, and endothelial dysfunction, hypoglycemia and glucose variability may exacerbate CVD. Moreover, significant qualitative and functional abnormalities of lipoproteins are present in even well-controlled T1D patients and are likely to play a role in the development of atherosclerosis and the promotion of CVD. According to recent research, immune system dysfunction, which is typical of auto-immune T1D, may also promote CVD, likely via inflammatory pathways. In addition, T1D patients who are overweight or obese exhibit an additional CV risk due to pathophysiological mechanisms that are similar to those seen in T2D.
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Affiliation(s)
- Bruno Vergès
- Endocrinology-Diabetology Department, University-Hospital of Dijon, Dijon, France; INSERM LNC-UMR1231, Medicine University, 21000 Dijon, France; Service Endocrinologie, Diabétologie et Maladies Métaboliques, CHU-Dijon, 14 rue Gaffarel, F-21000 Dijon, France.
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Pesantez M, Ebekozien O, Vendrame F. Type 1 Diabetes and Cardiovascular Health. Endocrinol Metab Clin North Am 2024; 53:151-163. [PMID: 38272593 DOI: 10.1016/j.ecl.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular disease (CVD). CVD occurs much earlier in people with T1D than in the general population, and several risk factors have been identified some of which are modifiable. Risk prediction models and imaging tests to detect early signs of CVD have not been extensively validated. Strategies to promote cardiovascular health (CVH) in T1D include identifying risk factors, early treatment to achieve CVH targets, and improving the education of health care providers and people with T1D.
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Affiliation(s)
- Maria Pesantez
- Jackson Memorial Hospital, 1450 Northwest 10 Avenue, Miami, FL 33136, USA
| | - Osagie Ebekozien
- T1D Exchange, 101 Federal Street Suite 440, Boston, MA 02110, USA
| | - Francesco Vendrame
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, 1450 Northwest 10 Avenue, Room 1086, Miami, FL 33136, USA.
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Duckworth C, Guy MJ, Kumaran A, O’Kane AA, Ayobi A, Chapman A, Marshall P, Boniface M. Explainable Machine Learning for Real-Time Hypoglycemia and Hyperglycemia Prediction and Personalized Control Recommendations. J Diabetes Sci Technol 2024; 18:113-123. [PMID: 35695284 PMCID: PMC10899844 DOI: 10.1177/19322968221103561] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The occurrences of acute complications arising from hypoglycemia and hyperglycemia peak as young adults with type 1 diabetes (T1D) take control of their own care. Continuous glucose monitoring (CGM) devices provide real-time glucose readings enabling users to manage their control proactively. Machine learning algorithms can use CGM data to make ahead-of-time risk predictions and provide insight into an individual's longer term control. METHODS We introduce explainable machine learning to make predictions of hypoglycemia (<70 mg/dL) and hyperglycemia (>270 mg/dL) up to 60 minutes ahead of time. We train our models using CGM data from 153 people living with T1D in the CITY (CGM Intervention in Teens and Young Adults With Type 1 Diabetes)survey totaling more than 28 000 days of usage, which we summarize into (short-term, medium-term, and long-term) glucose control features along with demographic information. We use machine learning explanations (SHAP [SHapley Additive exPlanations]) to identify which features have been most important in predicting risk per user. RESULTS Machine learning models (XGBoost) show excellent performance at predicting hypoglycemia (area under the receiver operating curve [AUROC]: 0.998, average precision: 0.953) and hyperglycemia (AUROC: 0.989, average precision: 0.931) in comparison with a baseline heuristic and logistic regression model. CONCLUSIONS Maximizing model performance for glucose risk prediction and management is crucial to reduce the burden of alarm fatigue on CGM users. Machine learning enables more precise and timely predictions in comparison with baseline models. SHAP helps identify what about a CGM user's glucose control has led to predictions of risk which can be used to reduce their long-term risk of complications.
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Affiliation(s)
- Christopher Duckworth
- Electronics and Computer Science, IT Innovation Centre, University of Southampton, Southampton, UK
| | - Matthew J. Guy
- Department of Medical Physics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Human-Computer Interaction for Health, University of Bristol, Bristol, UK
| | - Anitha Kumaran
- Child Health, Department of Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aisling Ann O’Kane
- Human-Computer Interaction for Health, University of Bristol, Bristol, UK
- UCL Interaction Centre, University College London, London, UK
| | - Amid Ayobi
- Human-Computer Interaction for Health, University of Bristol, Bristol, UK
| | - Adriane Chapman
- Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Paul Marshall
- Human-Computer Interaction for Health, University of Bristol, Bristol, UK
- UCL Interaction Centre, University College London, London, UK
| | - Michael Boniface
- Electronics and Computer Science, IT Innovation Centre, University of Southampton, Southampton, UK
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Chang M, Willis G. Approach to the Hypoglycemic Patient. Emerg Med Clin North Am 2023; 41:729-741. [PMID: 37758420 DOI: 10.1016/j.emc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Hypoglycemia is commonly encountered in the emergency department. Patients can present with a myriad of symptoms and its presentation can mimic other more serious diagnoses. Despite the relative ease of its management, clinicians often miss the diagnosis or mismanage it even when discovered. Glucose is an important energy source for the brain and failing to recognize hypoglycemia or mismanaging it can lead to permanent neurologic disability or death. Although it is important to replenish glucose in a rapid fashion, it is equally important to discover and manage the underlying etiology to prevent further episodes of hypoglycemia.
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Affiliation(s)
- Molly Chang
- Baylor University Medical Center, 3500 Gaston Avenue, 1st floor, Roberts Building, Dallas, TX 75246, USA; Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, TX 78229-3900, USA
| | - George Willis
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, TX 78229-3900, USA.
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Chambers ME, Nuibe EH, Reno-Bernstein CM. Brain Regulation of Cardiac Function during Hypoglycemia. Metabolites 2023; 13:1089. [PMID: 37887414 PMCID: PMC10608630 DOI: 10.3390/metabo13101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Hypoglycemia occurs frequently in people with type 1 and type 2 diabetes. Hypoglycemia activates the counter-regulatory response. Besides peripheral glucose sensors located in the pancreas, mouth, gastrointestinal tract, portal vein, and carotid body, many brain regions also contain glucose-sensing neurons that detect this fall in glucose. The autonomic nervous system innervates the heart, and during hypoglycemia, can cause many changes. Clinical and animal studies have revealed changes in electrocardiograms during hypoglycemia. Cardiac repolarization defects (QTc prolongation) occur during moderate levels of hypoglycemia. When hypoglycemia is severe, it can be fatal. Cardiac arrhythmias are thought to be the major mediator of sudden death due to severe hypoglycemia. Both the sympathetic and parasympathetic nervous systems of the brain have been implicated in regulating these arrhythmias. Besides cardiac arrhythmias, hypoglycemia can have profound changes in the heart and most of these changes are exacerbated in the setting of diabetes. A better understanding of how the brain regulates cardiac changes during hypoglycemia will allow for better therapeutic intervention to prevent cardiovascular death associated with hypoglycemia in people with diabetes. The aim of this paper is to provide a narrative review of what is known in the field regarding how the brain regulates the heart during hypoglycemia.
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Affiliation(s)
| | | | - Candace M. Reno-Bernstein
- Division of Endocrinology, Metabolism, and Diabetes, University of Utah School of Medicine, Salt Lake City, UT 84112, USA (E.H.N.)
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Papa G, Cannarella R, Condorelli RA, Finocchiaro C, Calogero AE, La Vignera S. Glycometabolic outcomes in adult type 1 diabetic patients switching to closed-loop systems. Diabetes Res Clin Pract 2023; 204:110907. [PMID: 37708979 DOI: 10.1016/j.diabres.2023.110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study aimed to evaluate glycometabolic outcomes in AID technology-naïve T1D patients after switching to Hybrid Closed Loop (HCL) and Advanced Hybrid Closed Loop (AHCL) systems. RESEARCH DESIGN AND METHODS This was a 12-month, prospective, observational, two-center study on 54 type 1 diabetes (T1D) patients aged 19-65 years managed with multiple daily injections (MDI) or Continuous Subcutaneous Insulin Infusion (CSII) in open-loop to evaluate the superiority in terms of effectiveness and safety of Automated Insulin Delivery (AID) systems. RESULTS HbA1c levels significantly improved at the end of the study. Time spent with glucose levels in target range (TIR70-180 mg/dL, 3.9-10 mmol/L) increased from 50.5 ± 15.6% at baseline to 73.6 ± 8.0% at 12 months (p < 0.001); time spent above range (TAR180-250 mg/dL, 10-13.9 mmol/L and TAR≥250 mg/dL, 13.9 mmol/L) decreased from 30.6 ± 9.0% and 14.2 ± 10.2 at baseline to 19.3 ± 5.3% and 4.8 ± 3.3% at 12 months (p < 0.001 for both), respectively; time spent below range (TBR54-69 mg/dL, 3-3.8 mmol/L and TBR<54 mg/dL, 3.0 mmol/L) decreased from 3.5 ± 2.6% and 1.2 ± 1.4% at baseline to 1.9 ± 1.5% and 0.4 ± 0.7% at the end of the study (p < 0.001 for both); coefficient of variation (CV) decreased from 35.9 ± 7.8% at baseline to 33.0 ± 5.3% (p < 0.05). Satisfaction with the new technology was scored as high. CONCLUSION AID-naïve T1D patients switching to HCL/AHCL systems have significantly and safely improved their glycometabolic outcomes with their high satisfaction with the new type of treatment.
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Affiliation(s)
- Giuseppe Papa
- Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Concetta Finocchiaro
- Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Jin M, Liu J, Liu K, Zhao Z, Sun S. Evaluation of sympathetic skin response for early diagnosis and follow-up of diabetic peripheral neuropathy in children. BMC Pediatr 2023; 23:483. [PMID: 37741963 PMCID: PMC10517453 DOI: 10.1186/s12887-023-04323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/20/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The morbidity of type 1 diabetes mellitus (T1DM) in children is increasing and diabetic peripheral neuropathy (DPN) is one of the main microvascular complications of T1DM. The aim of this study was to explore sympathetic skin response (SSR) characteristics in children with T1DM and analyze the value of early diagnosis and follow-up in T1DM complicated with DPN. METHODS Our prospective study enrolling 85 participants diagnosed with T1DM and 30 healthy controls (HCs) in the Children's Hospital of Hebei Province from 2017 to 2020. Compared the outcomes of SSR and nerve conduction study (NCS) in T1DM, and evaluated the variations in SSR and NCS of different durations, as well as changes after six months of therapy. RESULTS SSR latency of T1DM group showed statistical difference as compared to HCs (p < 0.05). The SSR test was more sensitive than the NCS test in the early diagnosis of T1DM with DPN (p < 0.05). The abnormal rates of SSR and NCS in long duration of disease were higher than those in short duration of disease (p < 0.05). Among 65 participants with diabetic neuropathy, the onset latencies of SSR were shortened and the NCS were improved after treatment (p < 0.05). CONCLUSIONS SSR could provide the accurate early diagnosis and follow-up of pediatric diabetic peripheral neuropathy.
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Affiliation(s)
- Mei Jin
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Jing Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Kang Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Ziwei Zhao
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Suzhen Sun
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China.
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China.
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Cederblad L, Eklund G, Vedal A, Hill H, Caballero-Corbalan J, Hellman J, Abrahamsson N, Wahlström-Johnsson I, Carlsson PO, Espes D. Classification of Hypoglycemic Events in Type 1 Diabetes Using Machine Learning Algorithms. Diabetes Ther 2023; 14:953-965. [PMID: 37052842 DOI: 10.1007/s13300-023-01403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION To improve the utilization of continuous- and flash glucose monitoring (CGM/FGM) data we have tested the hypothesis that a machine learning (ML) model can be trained to identify the most likely root causes for hypoglycemic events. METHODS CGM/FGM data were collected from 449 patients with type 1 diabetes. Of the 42,120 identified hypoglycemic events, 5041 were randomly selected for classification by two clinicians. Three causes of hypoglycemia were deemed possible to interpret and later validate by insulin and carbohydrate recordings: (1) overestimated bolus (27%), (2) overcorrection of hyperglycemia (29%) and (3) excessive basal insulin presure (44%). The dataset was split into a training (n = 4026 events, 304 patients) and an internal validation dataset (n = 1015 events, 145 patients). A number of ML model architectures were applied and evaluated. A separate dataset was generated from 22 patients (13 'known' and 9 'unknown') with insulin and carbohydrate recordings. Hypoglycemic events from this dataset were also interpreted by five clinicians independently. RESULTS Of the evaluated ML models, a purpose-built convolutional neural network (HypoCNN) performed best. Masking the time series, adding time features and using class weights improved the performance of this model, resulting in an average area under the curve (AUC) of 0.921 in the original train/test split. In the dataset validated by insulin and carbohydrate recordings (n = 435 events), i.e. 'ground truth,' our HypoCNN model achieved an AUC of 0.917. CONCLUSIONS The findings support the notion that ML models can be trained to interpret CGM/FGM data. Our HypoCNN model provides a robust and accurate method to identify root causes of hypoglycemic events.
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Affiliation(s)
- Lars Cederblad
- OneTwo Analytics Analytics AB, Fogdevreten 2A, 17165, Solna, Sweden
| | | | - Amund Vedal
- Modulai AB, Åsögatan 140, 11624, Stockholm, Sweden
| | - Henrik Hill
- Department of Women's and Children's Health, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - José Caballero-Corbalan
- Department of Medical Sciences, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - Jarl Hellman
- Department of Medical Sciences, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - Niclas Abrahamsson
- Department of Medical Sciences, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - Inger Wahlström-Johnsson
- Department of Women's and Children's Health, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden
| | - Per-Ola Carlsson
- Department of Medical Sciences, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden
- Department of Medical Cell Biology, Uppsala University, Husargatan 3, Box 571, 75123, Uppsala, Sweden
| | - Daniel Espes
- Department of Medical Sciences, Uppsala University-Akademiska Sjukhuset, 75185, Uppsala, Sweden.
- Department of Medical Cell Biology, Uppsala University, Husargatan 3, Box 571, 75123, Uppsala, Sweden.
- Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
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Rahim NS, McTaggart E, Cohen MC. Diabetes Related Deaths in a Tertiary Pediatric Referral Institution in England: The Value of Biochemical Analyses in Post-Mortem Samples. Pediatr Dev Pathol 2023; 26:115-123. [PMID: 36755423 DOI: 10.1177/10935266221146045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To establish the incidence of "diabetes-related death" (DRD) in children with known and unknown Diabetes Mellitus (DM) dying unexpectedly, and describe post-mortem (PM) biochemistry findings. PATIENTS AND METHODS PM reports from the previous 16-year period were reviewed. Cases of DRD were extracted. All available demographic, clinical, and autopsy data including laboratory analyses was retrieved. RESULTS 9/1376 (0.7%) DRD cases were identified. This was attributed to Diabetic Ketoacidosis in 7 and to Death in Bed Syndrome in 2. 4/9 cases were known diabetic and on insulin; whilst in 5/9 cases the diagnosis of DM was at PM. The mean age was 11.6 years (range 2.5-15). At PM, 4 cases were undernourished. The histology demonstrated pancreatic changes in keeping with DM in 3/9 and unremarkable pancreatic findings in 6/9. 3 cases also had autoimmune thyroiditis (1 also had myocarditis and Armanni-Ebstein nephropathy). Toxicological and biochemical analysis showed raised: β-hydroxybutyrate in 6, ketone bodies in 5 cases and raised HbA1c in 3c. CONCLUSION Type 1 DM is an infrequent but yet potentially preventable cause of death in children. Our findings highlight the value of routine biochemical and toxicological analysis in all PM examinations of infants and children dying suddenly and unexpectedly.
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Affiliation(s)
- Nur Syahrina Rahim
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia.,Department of Histopathology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Eleanor McTaggart
- Department of Histopathology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Marta C Cohen
- Department of Histopathology, Sheffield Children's NHS Foundation Trust, Sheffield, UK.,Department of Bone & Metabolism, University of Sheffield, Sheffield, UK
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13
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The Advanced Diabetes Technologies for Reduction of the Frequency of Hypoglycemia and Minimizing the Occurrence of Severe Hypoglycemia in Children and Adolescents with Type 1 Diabetes. J Clin Med 2023; 12:jcm12030781. [PMID: 36769430 PMCID: PMC9917934 DOI: 10.3390/jcm12030781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Hypoglycemia is an often-observed acute complication in the management of children and adolescents with type 1 diabetes. It causes inappropriate glycemic outcomes and may impair the quality of life in the patients. Severe hypoglycemia with cognitive impairment, such as a convulsion and coma, is a lethal condition and is associated with later-onset cognitive impairment and brain-structural abnormalities, especially in young children. Therefore, reducing the frequency of hypoglycemia and minimizing the occurrence of severe hypoglycemia are critical issues in the management of children and adolescents with type 1 diabetes. Advanced diabetes technologies, including continuous glucose monitoring and sensor-augmented insulin pumps with low-glucose suspension systems, can reduce the frequency of hypoglycemia and the occurrence of severe hypoglycemia without aggravating glycemic control. The hybrid closed-loop system, an automated insulin delivery system, must be the most promising means to achieve appropriate glycemic control with preventing severe hypoglycemia. The use of these advanced diabetes technologies could improve glycemic outcomes and the quality of life in children and adolescents with type 1 diabetes.
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14
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Pereira WVC, Vancea DMM, de Andrade Oliveira R, de Freitas YGPC, Lamounier RN, Silva Júnior WS, Fioretti AMB, Macedo CLD, Bertoluci MC, Zagury RL. 2022: Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes. Diabetol Metab Syndr 2023; 15:2. [PMID: 36593495 PMCID: PMC9806892 DOI: 10.1186/s13098-022-00945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/04/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION For individuals diagnosed with diabetes mellitus, the practice of properly oriented physical exercises brings significant benefits to the individual's health and is considered an indispensable tool for metabolic management. The individualization of exercise routines is an essential aspect for therapeutic success, despite the need to consider some general recommendations. This review is an authorized literal translation of the Brazilian Society of Diabetes (SBD) Guidelines 2021-2022, which is based on scientific evidence and provides guidance on physical activities and exercises aimed at individuals with type 1 and 2 diabetes. METHODS SBD designated 9 specialists from its "Department of Diabetes, Exercise & Sports" to author chapters on physical activities and exercises directed to individuals with type 1 and 2 diabetes. The aim of these chapters was to highlight recommendations in accordance with Evidence Levels, based on what is described in the literature. These chapters were analyzed by the SBD Central Committee, which is also responsible for the SBD 2021-2022 guidelines. Main clinical inquiries were selected to perform a narrated review by using MEDLINE via PubMed. Top available evidence, such as high-quality clinical trials, large observational studies and meta-analyses related to physical activity and exercise advisory, were analyzed. The adopted MeSh terms were [diabetes], [type 1 diabetes], [type 2 diabetes], [physical activity] [physical exercise]. RESULTS 17 recommendations were defined by the members. For this review, it was considered different Evidence Levels, as well as different Classes of Recommendations. As to Evidence Levels, the following levels were contemplated: Level A) More than one randomized clinical trial or a randomized clinical trial meta-analysis with low heterogeneity. Level B) Meta analysis with observational studies, one randomized clinical trial, sizeable observational studies and sub-groups analysis. Level C) Small non-randomized studies, cross-sectional studies, case control studies, guidelines or experts' opinions. In respect to Recommendation Classes, the following criteria were adopted: I. "Recommended": Meaning there was a consent of more than 90% of the panel; IIa. "Must be considered": meaning there is a general preference of the panel which 70-90% agrees; IIb. "Can be considered". 50-70% agrees; III Not recommended: There is a consensus that the intervention should not be performed. CONCLUSION Physical exercise aids on the glycemic control of type 2 diabetes individuals while also decreasing cardiovascular risk in individuals with type 1 and 2 diabetes. Individuals diagnosed with diabetes should perform combined aerobic and resistance exercises in order to manage the disease. In addition, exercises focusing on flexibility and balance should be specially addressed on elderly individuals. Diabetes individuals using insulin as therapeutic treatment should properly monitor glycemia levels before, during and after exercise sessions to minimize health incidents, such as hypoglycemia.
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Affiliation(s)
- William Valadares Campos Pereira
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
| | - Denise Maria Martins Vancea
- Research Group on Physical Exercise and Non-Transmissible Chronic Diseases from the Physical Education School of the University of Pernambuco (UPE), Recife, Brazil
- Physical Education School of the University of Pernambuco (UPE), Avenida Agamenon Magalhães, S/N-Santo Amaro, Recife,, PE CEP 50100-010 Brazil
| | - Ricardo de Andrade Oliveira
- Department of Obesity and Associated Diseases of the Brazilian Obesity Association (ABESO), Board of Directors of the Rio de Janeiro Society of Exercise Medicine and Sports, Rio de Janeiro, Brazil
| | | | | | - Wellington S. Silva Júnior
- Endocrinology Discipline, Department of Medicine I, Faculty of Medicine, Center of Biological Sciences, Federal University of Maranhão (UFMA), Praça Gonçalves Dias, 21, Centro, São Luís, MA CEP 65020-240 Brazil
| | | | | | - Marcello Casaccia Bertoluci
- Internal Medicine Department, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350 Building 12, 4th Floor, Porto Alegre, RS Brazil
| | - Roberto Luis Zagury
- Luiz Capriglione State Institute of Diabetes and Endocrinology (IEDE), Rio de Janeiro, Brazil
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15
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Heath M, Torpy DJ, Rushworth RL. An analysis of the utilisation of medical identification jewellery among children and young adults with type 1 diabetes mellitus in Australia. Endocrine 2023; 79:72-79. [PMID: 36334194 PMCID: PMC9813105 DOI: 10.1007/s12020-022-03224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
AIMS People with type 1 diabetes mellitus (T1DM) are at risk of life-threatening illness. Medical jewellery is recommended for emergencies, but its uptake is unknown. This study assessed the use of medical jewellery among people with T1DM aged 0-24 years in Australia. METHODS A cross sectional analysis of subscription data to the largest medical identification jewellery service in Australia was analysed by age, sex and geographic location using Australian population data from 2018. RESULTS There were 1599 people with T1DM aged 0-24 in the database, but only 1061 had an active subscription, corresponding to an active subscription rate of 13.28/100,000 population or ~5% of the estimated patient population. Half of the active subscribers were male (543/1061, 51/3%). The average age of active subscribers was 17; very few (n = 12, 1.1%) were aged less than 5; and the highest number (n = 141, 39%) was in the 20-24 age group. Active subscription rates varied significantly by geographic location. 88.4% of active subscribers had a diagnosis of T1DM or equivalent inscribed on their emblem, while engraved instructions for management in an emergency were only included in 1.8% of records (n = 19). CONCLUSIONS Medical jewellery subscription rates were lower than expected; increased with age; and varied significantly by state/territory. The use of medical identification jewellery may be limited by the lack of suitable engraved instructions for use in an emergency. Factors leading to low use should be addressed. Photo 1 Medical Jewellery with emblem.
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Affiliation(s)
- Madeleine Heath
- School of Medicine Sydney, The University of Notre Dame, Australia, Sydney, NSW, Australia.
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
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16
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Mistry S, Gouripeddi R, Reno CM, Abdelrahman S, Fisher SJ, Facelli JC. Detecting hypoglycemia-induced electrocardiogram changes in a rodent model of type 1 diabetes using shape-based clustering. PLoS One 2023; 18:e0284622. [PMID: 37200277 PMCID: PMC10194943 DOI: 10.1371/journal.pone.0284622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Sudden death related to hypoglycemia is thought to be due to cardiac arrhythmias. A clearer understanding of the cardiac changes associated with hypoglycemia is needed to reduce mortality. The objective of this work was to identify distinct patterns of electrocardiogram heartbeat changes that correlated with glycemic level, diabetes status, and mortality using a rodent model. Electrocardiogram and glucose measurements were collected from 54 diabetic and 37 non-diabetic rats undergoing insulin-induced hypoglycemic clamps. Shape-based unsupervised clustering was performed to identify distinct clusters of electrocardiogram heartbeats, and clustering performance was assessed using internal evaluation metrics. Clusters were evaluated by experimental conditions of diabetes status, glycemic level, and death status. Overall, shape-based unsupervised clustering identified 10 clusters of ECG heartbeats across multiple internal evaluation metrics. Several clusters demonstrating normal ECG morphology were specific to hypoglycemia conditions (Clusters 3, 5, and 8), non-diabetic rats (Cluster 4), or were generalized among all experimental conditions (Cluster 1). In contrast, clusters demonstrating QT prolongation alone or a combination of QT, PR, and QRS prolongation were specific to severe hypoglycemia experimental conditions and were stratified heartbeats by non-diabetic (Clusters 2 and 6) or diabetic status (Clusters 9 and 10). One cluster demonstrated an arrthymogenic waveform with premature ventricular contractions and was specific to heartbeats from severe hypoglycemia conditions (Cluster 7). Overall, this study provides the first data-driven characterization of ECG heartbeats in a rodent model of diabetes during hypoglycemia.
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Affiliation(s)
- Sejal Mistry
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States of America
| | - Ramkiran Gouripeddi
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States of America
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, Utah, United States of America
| | - Candace M Reno
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Samir Abdelrahman
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States of America
| | - Simon J Fisher
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States of America
| | - Julio C Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States of America
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, Utah, United States of America
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17
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Abraham MB, Karges B, Dovc K, Naranjo D, Arbelaez AM, Mbogo J, Javelikar G, Jones TW, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1322-1340. [PMID: 36537534 PMCID: PMC10107518 DOI: 10.1111/pedi.13443] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Discipline of Pediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Diana Naranjo
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ana Maria Arbelaez
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joyce Mbogo
- Department of Pediatric and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Ganesh Javelikar
- Department of Endocrinology and Diabetes, Max Super Speciality Hospital, New Delhi, India
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Discipline of Pediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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18
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Sanchez-Rangel E, Deajon-Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes. Ann N Y Acad Sci 2022; 1518:25-46. [PMID: 36202764 DOI: 10.1111/nyas.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the century since the discovery of insulin, diabetes has changed from an early death sentence to a manageable chronic disease. This change in longevity and duration of diabetes coupled with significant advances in therapeutic options for patients has fundamentally changed the landscape of diabetes management, particularly in patients with type 1 diabetes mellitus. However, hypoglycemia remains a major barrier to achieving optimal glycemic control. Current understanding of the mechanisms of hypoglycemia has expanded to include not only counter-regulatory hormonal responses but also direct changes in brain glucose, fuel sensing, and utilization, as well as changes in neural networks that modulate behavior, mood, and cognition. Different strategies to prevent and treat hypoglycemia have been developed, including educational strategies, new insulin formulations, delivery devices, novel technologies, and pharmacologic targets. This review article will discuss current literature contributing to our understanding of the myriad of factors that lead to the development of clinically meaningful hypoglycemia and review established and novel therapies for the prevention and treatment of hypoglycemia.
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Affiliation(s)
- Elizabeth Sanchez-Rangel
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jelani Deajon-Jackson
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janice Jin Hwang
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.,Division of Endocrinology, Department of Internal Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Shand JAD, Morrow P, Braatvedt G. Mortality after discharge from hospital following an episode of diabetic ketoacidosis. Acta Diabetol 2022; 59:1485-1492. [PMID: 35951132 DOI: 10.1007/s00592-022-01953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/01/2022]
Abstract
AIMS The rate of inpatient mortality associated with diabetic ketoacidosis (DKA) has steadily decreased in recent decades. However, there remains a significantly increased outpatient death rate following an episode of survived DKA. We undertook this study to investigate the observed increase in mortality following an episode of DKA. METHODS We completed a retrospective cohort study to investigate rates and causes of death in people admitted to our hospital with DKA between 2013 and 2018. DKA was confirmed by pre-defined biochemical parameters and cause of death data was extracted from multiple sources. Follow-up was for two years after discharge for all participants with one-year mortality being the main time point for analysis. RESULTS We identified 818 admissions to hospital with DKA, affecting 284 people. Twenty people died as inpatients and a further 40 people died during the two-year follow-up. Of these 60 participants, cause of death was able to be determined for 41 (68%), with most deaths occurring due to infection or macrovascular disease. Risk factors for death within a year of hospital discharge included older age, vascular complications of diabetes, intellectual impairment and residential care living. Those who survived an episode of DKA had a one-year age-corrected mortality rate 13 times higher than the general population. This was more marked in the younger cohort with those aged 15-39 years being 49 times more likely to die in the year after surviving a DKA admission compared to their general population counterparts. CONCLUSION An episode of diabetic ketoacidosis is associated with a significant outpatient mortality risk with most deaths due to infectious or macrovascular causes. This study should prompt investigation of predictive scoring tools to identify those at increased mortality risk after DKA and encourage the development of targeted interventions to reduce mortality.
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Affiliation(s)
- James A D Shand
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.
| | - Paul Morrow
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
| | - Geoff Braatvedt
- Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
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20
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Wu N, Jamnik VK, Koehle MS, Guan Y, Li Y, Kaufman K, Warburton DER. Associations between Sleep Characteristics and Cardiovascular Risk Factors in Adolescents Living with Type 1 Diabetes. J Clin Med 2022; 11:5295. [PMID: 36142941 PMCID: PMC9503476 DOI: 10.3390/jcm11185295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Adolescents living with type 1 diabetes (T1D) have an increased risk of developing cardiovascular disease. Sleep patterns have physiological and behavioral impacts on diabetes outcomes. This study aimed to investigate the associations between sleep patterns and CVD risk factors in adolescents living with T1D and their peers living without T1D. This cross-sectional study assessed CVD risk factors and sleep characteristics (and their associations) in adolescents, aged 12-18 years, living with T1D (n = 48) and their peers (n = 19) without T1D. Outcomes included blood pressure, lipid profiles, and sleep characteristics (accelerometry). Statistical differences between groups were determined with chi-square or independent samples t-tests. The associations between sleep characteristics and CVD risk factors were assessed with multivariate linear regression analyses. We found no significant differences between the two groups in terms of sleep duration, efficiency, sleep onset and offset, and frequency of awakenings, and there were associations between sleep efficiency and LDL-C (β = -0.045, p = 0.018, model R2 = 0.230) and triglycerides (β = -0.027, p = 0.012, model R2 = 0.222) after adjusting confounders (diabetes status, sex, age, pubertal stage) in all participants. In conclusion, adolescents with T1D and without T1D sleep less than the recommended eight hours per night. The associations between sleep efficiency and LDL-C and triglycerides are independent of sleep duration, regardless of sex, age, and pubertal stage.
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Affiliation(s)
- Nana Wu
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Veronica K. Jamnik
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Michael S. Koehle
- Division of Sports Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- School of Kinesiology, Faculty of Education, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Yanfei Guan
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Yongfeng Li
- College of Sports and Health, Shandong Sport University, Jinan 250102, China
| | - Kai Kaufman
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Darren E. R. Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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21
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Lanzinger S, Zimmermann A, Ranjan AG, Gani O, Pons Perez S, Akesson K, Majidi S, Witsch M, Hofer S, Johnson S, Pilgaard KA, Kummernes SJ, Robinson H, Eeg-Olofsson K, Ebekozien O, Holl RW, Svensson J, Skrivarhaug T, Warner J, Craig ME, Maahs D. A collaborative comparison of international pediatric diabetes registries. Pediatr Diabetes 2022; 23:627-640. [PMID: 35561091 DOI: 10.1111/pedi.13362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND An estimated 1.1 million children and adolescents aged under 20 years have type 1 diabetes worldwide. Principal investigators from seven well-established longitudinal pediatric diabetes registries and the SWEET initiative have come together to provide an international collaborative perspective and comparison of the registries. WORK FLOW Information and data including registry characteristics, pediatric participant clinical characteristics, data availability and data completeness from the Australasian Diabetes Data Network (ADDN), Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids), Diabetes prospective follow-up registry (DPV), Norwegian Childhood Diabetes Registry (NCDR), National Paediatric Diabetes Audit (NPDA), Swedish Childhood Diabetes Registry (Swediabkids), T1D Exchange Quality Improvement Collaborative (T1DX-QI), and the SWEET initiative was extracted up until 31 December 2020. REGISTRY OBJECTIVES AND OUTCOMES The seven diabetes registries and the SWEET initiative collectively show data of more than 900 centers and around 100,000 pediatric patients, the majority with type 1 diabetes. All share the common objectives of monitoring treatment and longitudinal outcomes, promoting quality improvement and equality in diabetes care and enabling clinical research. All generate regular benchmark reports. Main differences were observed in the definition of the pediatric population, the inclusion of adults, documentation of CGM metrics and collection of raw data files as well as linkage to other data sources. The open benchmarking and access to regularly updated data may prove to be the most important contribution from registries. This study describes aspects of the registries to enable future collaborations and to encourage the development of new registries where they do not exist.
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Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Osman Gani
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Shideh Majidi
- University of Colorado, Barbara Davis Center, Aurora, Colorado, USA
| | - Michael Witsch
- Department of Pediatrics DECCP, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Sabine Hofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Kasper A Pilgaard
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Siv Janne Kummernes
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Holly Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Katarina Eeg-Olofsson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA.,University of Mississippi School of Population Health, Jackson, Mississippi, USA
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.,German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jannet Svensson
- Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torild Skrivarhaug
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Maria E Craig
- Charles Perkins Centre Westmead, University of Sydney, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of NSW, Sydney, New South Wales, Australia
| | - David Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford, California, USA
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22
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Jones J, James S, Brown F, O'Neal D, I Ekinci E. Dead in bed - A systematic review of overnight deaths in type 1 diabetes. Diabetes Res Clin Pract 2022; 191:110042. [PMID: 36007797 DOI: 10.1016/j.diabres.2022.110042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Type 1 diabetes is a significant, life-long condition which affects many people worldwide. One of the most feared causes of type 1 diabetes mortality, overnight mortality, often caused by the dead in bed syndrome, is largely underreported. A systematic literature search was undertaken to understand the frequency, risk factors, causes and impact that diabetes-related technologies have on overnight mortality, in this population. METHODS MEDLINE (Ovid), Embase (Ovid) and Cochrane were searched to June 2021, using defined inclusion and exclusion criteria. Quality appraisal was undertaken. RESULTS Overall, 26 records met the inclusion criteria. Large-scale cohort studies examined data up to 2013, and there were no studies published after 2018. The proportion of deaths attributable to the dead in bed syndrome was between 2 and 5% of deaths in children, adolescents, and young adults, with a slight decrease in proportion of dead in bed syndrome since 1991. CONCLUSION Overnight mortality is occurring for people with type 1 diabetes, reported as recently as in 2018. Living alone, alcohol and illicit substances consistently appear as risk factors, and the impact of technology on overnight mortality is not fully understood, with more recent data, from larger cohort studies being required.
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Affiliation(s)
- Jessica Jones
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Endocrinology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Steven James
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 1 Moreton Parade, Petrie, Queensland 4502, Australia
| | - Fran Brown
- Melbourne Diabetes Education & Support, 76 Edwin St, Heidelberg Heights, Victoria 3081, Australia
| | - David O'Neal
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Endocrinology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Elif I Ekinci
- Department of Medicine, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Endocrinology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia; Australian Centre of Accelerating Diabetes Innovations (ACADI), University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
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23
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Myers LA, Swanson KM, Glasgow AE, McCoy RG. Management and Outcomes of Severe Hypoglycemia Treated by Emergency Medical Services in the U.S. Upper Midwest. Diabetes Care 2022; 45:1788-1798. [PMID: 35724305 PMCID: PMC9346993 DOI: 10.2337/dc21-1811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine factors associated with emergency department (ED) transport after hypoglycemia treated by emergency medical services (EMS) and assess the impact of ED transport on severe hypoglycemia recurrence. RESEARCH DESIGN AND METHODS We retrospectively analyzed electronic health records of a multistate advanced life support EMS provider and an integrated healthcare delivery system serving an overlapping geographic area in the upper Midwest. For adults with diabetes treated by EMS for hypoglycemia between 2013 and 2019, we examined rates of ED transport, factors associated with it, and its impact on rates of recurrent hypoglycemia requiring EMS, ED, or hospital care within 3, 7, and 30 days. RESULTS We identified 1,977 hypoglycemia-related EMS encounters among 1,028 adults with diabetes (mean age 63.5 years [SD 17.7], 55.2% male, 87.4% non-Hispanic White, 42.4% rural residents, and 25.6% with type 1 diabetes), of which 46.4% resulted in ED transport (31.1% of calls by patients with type 1 diabetes and 58.0% of calls by patients with type 2 diabetes). Odds of ED transport were lower in patients with type 1 diabetes (odds ratio [OR] 0.44 [95% CI 0.31-0.62] vs. type 2 diabetes) and higher in patients with prior ED visits (OR 1.38 [95% CI 1.03-1.85]). Within 3, 7, and 30 days, transported patients experienced recurrent severe hypoglycemia 2.8, 5.2, and 10.6% of the time, respectively, compared with 7.4, 11.2, and 22.8% of the time among nontransported patients (all P < 0.001). This corresponds to OR 0.58 (95% CI 0.42-0.80) for recurrent severe hypoglycemia within 30 days for transported versus nontransported patients. When subset by diabetes type, odds of recurrent severe hypoglycemia among transported patients were 0.64 (95% CI 0.43-0.96) and 0.42 (95% CI 0.24-0.75) in type 1 and type 2 diabetes, respectively. CONCLUSIONS Transported patients experienced recurrent hypoglycemia requiring medical attention approximately half as often as nontransported patients, reinforcing the importance of engaging patients in follow-up to prevent recurrent events.
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Affiliation(s)
| | - Kristi M Swanson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Amy E Glasgow
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Rozalina G McCoy
- Mayo Clinic Ambulance Service, Rochester, MN.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.,Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN
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24
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Haas A, Borsook D, Adler G, Freeman R. Stress, hypoglycemia, and the autonomic nervous system. Auton Neurosci 2022; 240:102983. [PMID: 35417827 DOI: 10.1016/j.autneu.2022.102983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Stress can be classified as either psychosocial or physiologic. Physiologic stress refers to stresses due to acute illness, trauma, pain, hypoglycemia, and sleep deprivation-much less is known regarding its health consequences. This review focuses on hypoglycemia as a model to further investigate physiological stress. Experimental mild to moderate hypoglycemia is a paradigmatic physiological stress that evokes autonomic, neuroendocrine, and immune responses. Hypoglycemic stress is an ideal model to examine the interactions and consequences of physiological stress on the autonomic nervous system. Acute hypoglycemia has been demonstrated to increase inflammatory markers, prolong QTc, and impair cardiac-vagal baroreflex sensitivity. Some of these consequences may not reverse completely when euglycemia is restored. For example, there is attenuation of the cardiac-vagal baroreflex, attenuation of the vascular sympathetic baroreflex (muscle sympathetic nerve activity response to transient hypotension), and attenuation of the catecholamine response to lower body negative pressure that is present the next day after hypoglycemia has resolved.
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Affiliation(s)
- Andrea Haas
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Gail Adler
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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25
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Urakami T, Terada H, Yoshida K, Kuwabara R, Mine Y, Aoki M, Shoji Y, Suzuki J, Morioka I. Comparison of the clinical effects of intermittently scanned and real-time continuous glucose monitoring in children and adolescents with type 1 diabetes: A retrospective cohort study. J Diabetes Investig 2022; 13:1745-1752. [PMID: 35532954 PMCID: PMC9533045 DOI: 10.1111/jdi.13830] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS /Introduction The aim of the study was to compare two continuous glucose monitoring (CGM) systems, intermittently scanned CGM (isCGM) and real-time CGM (rtCGM), to determine which system achieved better glycemic control in pediatric patients. MATERIALS AND METHODS We conducted a retrospective cohort study of children and adolescents with type 1 diabetes and compared the time in range (TIR) (70-180 mg/dL), time below range (TBR) (< 70 mg/dL), and time above range (TAR) (> 180 mg/dL), and estimated HbA1c (eA1c) levels between patients on isCGM and rtCGM. RESULTS Of the 112 participants, 76 (67.9%) used isCGM and 36 (32.1%) used rtCGM for glycemic management. Patients on rtCGM had significantly greater TIR (57.7% ± 12.3% vs. 52.3% ± 12.3%, P = 0.0368), and had significantly lower TBR (4.3% ± 2.7% vs. 10.2% ± 5.4%, P < 0.001) than those on isCGM but there was no significant difference in the TAR (37.4% ± 12.9% vs. 38.0% ± 12.5%, P = 0.881) or the eA1c levels (7.4% ± 0.9% vs. 7.5% ± 0.8%, P = 0.734) between the two groups. CONCLUSIONS Pediatric patients with type 1 diabetes on rtCGM also showed more beneficial effects for increase of TIR with notably reduction of TBR than those on isCGM. Real-time CGM may provide better glycemic control than isCGM in children with type 1 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroki Terada
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Kei Yoshida
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Remi Kuwabara
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mine
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Masako Aoki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuko Shoji
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Junichi Suzuki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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26
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Bailey NC, Dimsits J, Hammer M, Kendall DM, Bailey TS. A Comparative Study of Dasiglucagon Ready-to-Use Autoinjector and Glucagon Emergency Kit During Rescue from Simulated Severe Hypoglycemia. Diabetes Technol Ther 2022; 24:231-240. [PMID: 34809479 PMCID: PMC9057872 DOI: 10.1089/dia.2021.0367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Severe hypoglycemic episodes are life-threatening events demanding rapid administration of glucagon by a caregiver or bystander. The glucagon analog dasiglucagon is stable in aqueous formulation and therefore suitable for delivery in a ready-to-use autoinjector, potentially increasing speed and ease of use compared with standard glucagon emergency kits (GEKs). Methods: In an open label, randomized, crossover, comparative device handling study, trained caregivers and untrained bystanders administered the dasiglucagon autoinjector or Eli Lilly GEK to manikins in a simulated emergency hypoglycemia situation. Results: In total, 54 participants were randomized (18 patient-caregiver pairs and 18 bystanders). Overall, 94% of trained caregivers were able to administer the dasiglucagon autoinjector successfully within 15 min, compared with 56% for the GEK (P < 0.05). A greater proportion of trained caregivers and untrained bystanders successfully prepared and administered the dasiglucagon autoinjector within 2 min compared with the GEK (P < 0.005 and P < 0.05, respectively). Time to successful completion was also significantly faster with the dasiglucagon autoinjector than with the GEK (P < 0.005 for both groups). Most study participants preferred the dasiglucagon autoinjector over the GEK (94%, P < 0.001) and rated it as easier (90%, P < 0.001) and less stressful to use (94%, P < 0.001) than the GEK. Conclusion: Dasiglucagon autoinjector was more rapidly and reliably administered, and users reported greater ease of use and usage satisfaction than with the GEK. Thus, dasiglucagon autoinjector has the potential to improve speed and ease of treatment in severe hypoglycemic events, providing a better usage experience for rescuing individuals and enabling faster recovery for patients.
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27
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Zaremba N, Robert G, Allan J, Harrison A, Brown J, Konstantara E, Rosenthal M, Pillay D, Beckwith A, Treasure J, Hopkins D, Ismail K, Stadler M. Developing a novel intervention for type 1 diabetes and disordered eating using a participatory action design process: Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY). Diabet Med 2022; 39:e14749. [PMID: 34821402 DOI: 10.1111/dme.14749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
AIMS To develop a cognitive behavioural therapy-based intervention for people with type 1 diabetes and disordered eating using Experience-Based Co-Design as part of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY). METHODS Fifteen people with type 1 diabetes and experience of disordered eating (33 ± 11 years old, 22 ± 12 years diabetes duration) and 25 healthcare professionals working in type 1 diabetes or eating disorders (44 ± 9 years old; 14 ± 10 years of professional experience) attended six Experience-Based Co-Design workshops from July 2019 to March 2020 to collaboratively develop intervention content. RESULTS We developed a cognitive behaviour therapy intervention 'toolkit' that can be tailored for individual patient needs. Participants designed and revised toolkit materials to ensure acceptability and relevance for people with diabetes and disordered eating by engaging in guided discussion, brainstorming, and rapid testing to review toolkit prototypes in an iterative process. Workshop themes were 'Insulin titration'; 'Hypoglycaemia'; 'Coming to terms with diabetes'; 'Fear of weight gain'; 'Toolkit revision'; and 'Practical elements of STEADY therapy'. The intervention is focussed on improving diabetes self-care and embedded in a multidisciplinary healthcare approach. The intervention will be delivered in 12 sessions by a diabetes specialist nurse trained in cognitive behavioural therapy. CONCLUSIONS Through an iterative co-design process, people with type 1 diabetes and healthcare professionals collaboratively developed a novel intervention toolkit that can be used with a wide range of disordered eating presentations. The intervention will be tested in the STEADY feasibility randomised controlled trial.
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Affiliation(s)
- Natalie Zaremba
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jacqueline Allan
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Amy Harrison
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
- Department of Psychology and Human Development, University College London, Institute of Psychiatry, London, UK
| | - Jennie Brown
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Diabetes Centre, King's College Hospital, London, UK
| | - Emmanouela Konstantara
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Divina Pillay
- St Vincent Square Eating Disorder Unit, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
| | - Marietta Stadler
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
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28
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The Other Face of Insulin—Overdose and Its Effects. TOXICS 2022; 10:toxics10030123. [PMID: 35324747 PMCID: PMC8955302 DOI: 10.3390/toxics10030123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Insulin is the most effective glycemic-lowering drug, and for people suffering from type 1 diabetes it is a life-saving drug. Its self-dosing by patients may be associated with a higher risk of overdose, both accidental and deliberate. Insulin-induced hypoglycemia causes up to 100,000 emergency department calls per year. Cases of suicide attempts using insulin have been described in the literature since its introduction into therapy, and one of the important factors in their occurrence is the very fact of chronic disease. Up to 90% of patients who go to toxicology wards overdose insulin consciously. Patients with diabetes are burdened with a 2–3 times higher risk of developing depression compared to the general population. For this reason, it is necessary to develop an effective system for detecting a predisposition to overdose, including the assessment of the first symptoms of depression in patients with diabetes. A key role is played by a risk-conscious therapeutic team, as well as education. Further post-mortem testing is also needed for material collection and storage, as well as standardization of analytical methods and interpretation of results, which would allow for more effective detection and analysis of intentional overdose—both by the patient and for criminal purposes.
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29
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James S, Perry L, Palmer C, Harris M, Siram D, Lowe J. Web-Based Questionnaire for Healthcare Professionals on Psychosocial Support for Adolescents and Young Adults with Type 1 Diabetes. Diabetes Ther 2022; 13:355-365. [PMID: 35103935 PMCID: PMC8873327 DOI: 10.1007/s13300-022-01202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adolescence and young adulthood is a challenging period, particularly for those living with chronic disease such as type 1 diabetes (T1D). Effective professional support is associated with better diabetes outcomes, but little is known about what determines healthcare professionals' decision-making for therapeutic intervention, and how to support this. Our study aimed to determine healthcare professionals' (HCPs) self-rated awareness, capability, opportunity and motivation to provide support for psychosocial issues in the management of T1D with adolescents and young adults; and to identify factors independently predictive of HCPs' perceptions of their confidence in, and perceived importance of, addressing psychosocial issues in this population. METHODS Survey design was used, and data collected using an anonymous web-based questionnaire based on the Capability-Opportunity-Motivation Behaviour (COM-B) framework. The study was advertised to members of the Australian Diabetes Society, and National Association of Diabetes Centres. RESULTS Of 98 respondents, 57 (58.2%) were female. Confidence and perceived importance summary scores were not significantly associated with demographic characteristics. HCPs agreed that both diabetes-dependent and external non-diabetes-specific influences were important components of psychosocial management, but self-rated themselves as less confident in their ability to provide care for these aspects. Few respondents regularly encountered psychosocial issues that they believed would lead to improved outcomes if addressed and not all HCPs knew how to access psychosocial support for their adolescent patients. CONCLUSION Our findings indicate discrepancies between HCPs' self-rated capability and perceived motivation to provide support relating to psychosocial issues in the management of T1D for adolescents and young adults. Equitable opportunities are needed for training and support, to increase HCPs' understanding and hence their perceptions of the importance and of their confidence in addressing psychosocial issues, especially considering the high levels of risk of these young people for such problems.
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Affiliation(s)
- Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Moreton Parade, Petrie, Queensland 4502 Australia
| | - Lin Perry
- Faulty of Health, University of Technology Sydney/South East Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales 2031 Australia
| | - Christine Palmer
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Tallon Street, Caboolture, Queensland 4510 Australia
| | - Margaret Harris
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
| | - Deepa Siram
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Tallon Street, Caboolture, Queensland 4510 Australia
| | - Julia Lowe
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
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30
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Wang S, Tan Z, Wu T, Shen Q, Huang P, Wang L, Liu W, Song H, Lin M, Shi X, Li X. Largest Amplitude of Glycemic Excursion Calculating from Self-Monitoring Blood Glucose Predicted the Episodes of Nocturnal Asymptomatic Hypoglycemia Detecting by Continuous Glucose Monitoring in Outpatients with Type 2 Diabetes. Front Endocrinol (Lausanne) 2022; 13:858912. [PMID: 35498416 PMCID: PMC9047895 DOI: 10.3389/fendo.2022.858912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Nocturnal asymptomatic hypoglycemia (NAH) is a serious complication of diabetes, but it is difficult to be detected clinically. This study was conducted to determine the largest amplitude of glycemic excursion (LAGE) to predict the episodes of NAH in outpatients with type 2 diabetes. METHODS Data were obtained from 313 outpatients with type 2 diabetes. All subjects received continuous glucose monitoring (CGM) for consecutive 72 hours. The episodes of NAH and glycemic variability indices (glucose standard deviation [SD], mean amplitude of plasma glucose excursion [MAGE], mean blood glucose [MBG]) were accessed via CGM. LAGE was calculated from self-monitoring blood glucose (SMBG). RESULTS A total of 76 people (24.3%) had NAH. Compared to patients without NAH, patients with NAH showed higher levels of glucose SD (2.4 ± 0.9 mmol/L vs 1.7 ± 0.9 mmol/L, p <0.001), MAGE (5.2 ± 2.1 mmol/L vs 3.7 ± 2.0, p<0.001) and LAGE (4.6 ± 2.3 mmol/L vs 3.8 ± 1.9 mmol/L, p=0.007), and lower level of MBG (7.5 ± 1.5 mmol/L vs 8.4 ± 2.2 mmol/L, p=0.002). LAGE was significantly associated with the incidence of NAH and time below rang (TBR) in model 1 [NAH: 1.189 (1.027-1.378), p=0.021; TBR: 0.008 (0.002-0.014), p=0.013] with adjustment for age, BMI, sex, work, hyperlipidemia, complication and medication, and in model 2 [NAH: 1.177 (1.013-1.367), p=0.033; TBR: 0.008 (0.002-0.014), p=0.012] after adjusting for diabetes duration based on model 1, as well as in model 3 [NAH: 1.244 (1.057-1.464), p=0.009; TBR: 0.009 (0.002-0.016), p=0.007] with further adjustment for HbA1c based on model 2. In addition, no significant interactions were found between LAGE and sex, age, HbA1c, duration of diabetes, BMI and insulin therapy on the risk of NAH. The receiver operator characteristic (ROC) curve shows the ideal cutoff value of LAGE for the prediction of NAH was 3.48 mmol/L with 66.7% sensitivity, 50% specificity and 0.587 (95% CI: 0.509-0.665) of area under the ROC curve. CONCLUSIONS High glycemic variability is strongly associated with the risk of NAH. The LAGE based on SMBG could be an independent predictor of NAH for outpatients with type 2 diabetes, and LAGE greater than 3.48 mmol/L could act as a warning alarm for high risk of NAH in daily life.
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Affiliation(s)
- Shoubi Wang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhenhua Tan
- Xiahe Branch of the Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ting Wu
- The School of Clinical of Medicine, Fujian Medical University, Fuzhou, China
| | - Qingbao Shen
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Peiying Huang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Liying Wang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei Liu
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Haiqu Song
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiulin Shi
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Xuejun Li, ; Xiulin Shi,
| | - Xuejun Li
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Xuejun Li, ; Xiulin Shi,
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Nakhleh A, Shehadeh N. Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention. World J Diabetes 2021; 12:2036-2049. [PMID: 35047118 PMCID: PMC8696639 DOI: 10.4239/wjd.v12.i12.2036] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/16/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia. Episodes of hypoglycemia are associated with physical and psychological morbidity. The fear of hypoglycemia constitutes a barrier that impairs the patient's ability to reach good glycemic control. To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. In this review, we present a comprehensive update on the treatment and prevention of hypoglycemia in type 1 and type 2 diabetic patients.
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Affiliation(s)
- Afif Nakhleh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Naim Shehadeh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
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32
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Uduku C, Pendolino V, Godsland I, Oliver N, Reddy M, Fothergill RT. Cross-sectional analysis of emergency hypoglycaemia and outcome predictors among people with diabetes in an urban population. Diabet Med 2021; 38:e14654. [PMID: 34278609 DOI: 10.1111/dme.14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Out-of-hospital hypoglycaemia is a common complication for individuals with diabetes mellitus and represents a significant burden to emergency medical services (EMS). We aim to identify the factors associated with receiving parenteral treatment and hospital conveyance. METHODS We retrospectively analysed a 6-month data set of all London EMS hypoglycaemia. Individuals with a known diabetes diagnosis were included in our analysis and stratified as either having type 1 diabetes or type 2 diabetes. RESULTS A total of 2862 incidents occurred within the area served by London Ambulance Service between January and June 2018. Fifty percent of incidents required parenteral treatment (intravenous glucose or intramuscular glucagon) and were conveyed to hospital. A higher arrival of blood glucose, intact consciousness and receiving oral glucose treatment were all negative predictors for requiring parenteral therapy. Forty-three percent of incidents were labelled as 'hypoglycaemia' by the EMS call handler, and greater odds of hospitalisation were observed among incidents that received parenteral treatment (OR 2.52 [95% CI 1.46, 4.33] p < 0.01) and individuals with type 2 diabetes (OR 2.67 [95% CI 1.52, 4.71] p < 0.01). Repeated callouts from 2% (n = 50) of individuals accounted for 10% (286) of all incidents attended, and 56.4% of individuals attended by EMS on more than one occasion had type 1 diabetes. CONCLUSIONS/INTERPRETATION Severe hypoglycaemia requiring emergency service attendance remains common, as does the requirement for parenteral therapy and conveyance to hospital. Early intervention, education and improved accessibility to risk prevention strategies may reduce the necessity for emergency parenteral treatment and hospitalisation, especially among individuals suffering from recurrent hypoglycaemia and high-risk individuals with type 2 diabetes.
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Affiliation(s)
- Chukwuma Uduku
- Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Valentina Pendolino
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Ian Godsland
- Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Nick Oliver
- Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Monika Reddy
- Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Rachael T Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
- Clinical Trials Unit, Warwick University, Coventry, UK
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Gómez-Peralta F, Menéndez E, Conde S, Conget I, Novials A. Clinical characteristics and management of type 1 diabetes in Spain. The SED1 study. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:642-653. [PMID: 34906345 DOI: 10.1016/j.endien.2021.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the sociodemographic and clinical profile of a representative sample of people with type 1 diabetes mellitus (DM1) in Spain and identify factors associated with glycemic control. MATERIAL AND METHODS A cross-sectional observational study was carried out in adults and children with DM1 treated in 75 Spanish public hospitals, geographically distributed in order to be representative of the Spanish population. Within each center, the patients were included on a consecutive basis as they visited the clinic. They were interviewed, and their clinical histories were reviewed. A descriptive statistical analysis was made, and factors associated with HbA1c were analysed using multivariate linear regression analysis. RESULTS A total of 647 patients were included: 55.3% females, aged 36.6 ± 14.4 years, 97.2% Caucasians, BMI 24.7 ± 4.4 kg/m2 (12.1% ≥ 30 kg/m2), and 74.0% had secondary / university education. A total of 20.2% were active smokers. The mean time from the diagnosis of DM1 was 17.9 ± 12.0 years. A total of 48.7% presented comorbidities: 19.3% retinopathy and 16.4% hypothyroidism. As regards treatment for DM1, 76.5% received basal-bolus insulin therapy and 20.7% continuous subcutaneous insulin infusion (CSII); 51.0% of the patients used an insulin/carbohydrate ratio (ICR), with 4.6 ± 1.6 self-monitored capillary blood glucose (SMCBG) measurements a day, and 24.8% used continuous glucose monitoring (CGM). The mean HbA1c value was 7.6 ± 1.1% (30% below 7%). Metabolic control improved (lower HbA1c) with more daily SMCBG (B = -0.053; p = 0.009), a higher educational level (B = 0.461; P < 0.001), greater number of hypoglycemia episodes (B = -0.253; P = 0.018) and carbohydrate counting (B = -0.190; P = 0.048), and worsened the longer the duration of the disease (B = 0.010; P = 0.010), higher total dose of insulin (B = 0.010; P < 0.0001), poorer adherence to diet (B = 0.650; P < 0.0001) and a family history of DM (B = -0.233; P = 0.007). CONCLUSIONS The management of patients with DM1 in Spain, as well as the treatment they receive, is similar to that seen in other Western countries. Blood glucose control is associated with educational level, disease duration, and the characteristics of treatment and self-care.
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Affiliation(s)
| | - Edelmiro Menéndez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central Asturias, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Ignacio Conget
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones Biomédicas en Red sobre Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Anna Novials
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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La Sala L, Pontiroli AE. New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions. Int J Mol Sci 2021; 22:ijms221910643. [PMID: 34638984 PMCID: PMC8508740 DOI: 10.3390/ijms221910643] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
The goal of diabetes care is to achieve and maintain good glycemic control over time, so as to prevent or delay the development of micro- and macrovascular complications in type 1 (T1D) and type 2 diabetes (T2D). However, numerous barriers hinder the achievement of this goal, first of all the frequent episodes of hypoglycemia typical in patients treated with insulin as T1D patients, or sulphonylureas as T2D patients. The prevention strategy and treatment of hypoglycemia are important for the well-being of patients with diabetes. Hypoglycemia is strongly associated with an increased risk of cardiovascular disease in diabetic patients, due probably to the release of inflammatory markers and prothrombotic effects triggered by hypoglycemia. Treatment of hypoglycemia is traditionally based on administration of carbohydrates or of glucagon via intramuscular (IM) or subcutaneous injection (SC). The injection of traditional glucagon is cumbersome, such that glucagon is an under-utilized drug. In 1983, it was shown for the first time that intranasal (IN) glucagon increases blood glucose levels in healthy volunteers, and in 1989-1992 that IN glucagon is similar to IM glucagon in resolving hypoglycemia in normal volunteers and in patients with diabetes, both adults and children. IN glucagon was developed in 2010 and continued in 2015; in 2019 IN glucagon obtained approval in the US, Canada, and Europe for severe hypoglycemia in children and adults. In the 2010s, two ready-to-use injectable formulations, a stable non-aqueous glucagon solution and the glucagon analog dasiglucagon, were developed, showing an efficacy similar to traditional glucagon, and approved in the US in 2020 and in 2021, respectively, for severe hypoglycemia in adults and in children. Fast-acting glucagon (nasal administration and injected solutions) appears to represent a major breakthrough in the treatment of severe hypoglycemia in insulin-treated patients with diabetes, both adults and children. It is anticipated that the availability of fast-acting glucagon will expand the use of glucagon, improve overall metabolic control, and prevent hypoglycemia-related complications, in particular cardiovascular complications and cognitive impairment.
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Affiliation(s)
- Lucia La Sala
- IRCCS MultiMedica, Lab of Diabetology and Dysmetabolic Disease, PST Via Fantoli 16/15, 20138 Milan, Italy
- Correspondence: ; Tel.: +39-02-5540-6534 (ext. 6587)
| | - Antonio E. Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20100 Milan, Italy;
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Lu CL, Chang YH, Martini S, Chang MF, Li CY. Overall and Cause-Specific Mortality in Patients With Type 1 Diabetes Mellitus: A Population-Based Cohort Study in Taiwan From 1998 Through 2014. J Epidemiol 2021; 31:503-510. [PMID: 32741854 PMCID: PMC8328860 DOI: 10.2188/jea.je20200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes. Methods A cohort of 17,203 patients with type 1 diabetes were identified from Taiwan’s National Health Insurance claims in the period of 1998–2014. Person-years were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Age, sex, and calendar year standardized mortality ratios (SMRs) were calculated with reference to the general population. Results In up to 17 years of follow-up, 4,916 patients died from 182,523 person-years. Diabetes (30.15%), cancer (20.48%), circulatory diseases (13.14%), and renal diseases (11.45%) were the leading underlying causes of death. Mortality rate (26.93 per 1,000 person-years) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1,000 person-years), followed by cancer (5.52 per 1,000 person-years), and circulatory diseases (3.54 per 1,000 person-years). The all-cause SMR was significantly elevated at 4.16 (95% confidence interval, 4.04–4.28), with a greater all-cause SMR noted in females than in males (4.62 vs 3.79). The cause-specific SMR was highly elevated for diabetes (SMR, 16.45), followed by renal disease (SMR, 14.48), chronic hepatitis and liver cirrhosis (SMR, 4.91) and infection (SMR, 4.59). All-cause SMRs were also significantly increased for all ages, with the greatest figure noted for 15–24 years (SMR, 8.46). Conclusions Type 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease.
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Affiliation(s)
- Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga
| | | | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University.,Department of Epidemiology, Faculty of Public Health, Universitas Airlangga.,Department of Public Health, College of Public Health, China Medical University.,Department of Healthcare Administration, College of Medical and Health Science, Asia University
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Urakami T, Yoshida K, Kuwabara R, Mine Y, Aoki M, Suzuki J, Morioka I. Significance of "Time below Range" as a Glycemic Marker Derived from Continuous Glucose Monitoring in Japanese Children and Adolescents with Type 1 Diabetes. Horm Res Paediatr 2021; 93:251-257. [PMID: 32950993 DOI: 10.1159/000510454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We evaluated the frequencies of various glycemic markers derived from continuous glucose monitoring in Japanese children and adolescents with type 1 diabetes and assessed the significance of hypoglycemia duration. METHODS We enrolled 85 children and adolescents (36 boys and 49 girls) with type 1 diabetes who used FreeStyle® Libre in the present study. Frequencies of blood glucose levels as time within target range (TIR; 70-180 mg/dL), time below target range (TBR; <70 mg/dL), time below extreme hypoglycemia range (TBER; <54 mg/dL), and time above range (TAR; >180 mg/dL) were assessed during a 3-month study period. Furthermore, we evaluated the intraday frequencies of TBR and TBER. RESULTS The mean frequencies of TIR, TBR, and TAR were 52.7 ± 11.3%, 10.8 ± 5.4%, and 36.5 ± 10.8%, respectively, whereas the mean frequency of TBER was 1.1 ± 0.9% (0-3.0%); there was no clinical episode of severe hypoglycemia. The mean frequency of TBR was significantly greater in 0-6 h (16.9 ± 5.2%) than in 6-12 h (7.8 ± 2.9%) and 18-24 h (6.8 ± 4.8%; p < 0.01) time zones, respectively. DISCUSSION/CONCLUSION We found similar TIR and comparatively higher TBR frequencies, particularly during sleep, than those that were previously reported. Possible reasons for the higher frequency of TBR include differences in the quality of insulin treatment and diabetes care between the present study and the European studies. The utilization of advanced technologies, such as a predictive low-glucose suspend-function pump or closed-loop therapy, can reduce the frequency of TBR, with a consequent increase in TIR frequency and comprehensive improvement in glycemic control.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan,
| | - Kei Yoshida
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Remi Kuwabara
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mine
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Masako Aoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Junichi Suzuki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Slow but Steady-The Responsiveness of Sympathoadrenal System to a Hypoglycemic Challenge in Ketogenic Diet-Fed Rats. Nutrients 2021; 13:nu13082627. [PMID: 34444787 PMCID: PMC8398867 DOI: 10.3390/nu13082627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
The sympathoadrenal counterregulatory response to hypoglycemia is critical for individuals with type 1 diabetes due to impaired ability to produce glucagon. Ketogenic diets (KD) are an increasingly popular diabetes management tool; however, the effects of KD on the sympathoadrenal response are largely unknown. Here, we determined the effects of KD-induced ketosis on the sympathoadrenal response to a single insulin-induced hypoglycemic challenge. We investigated how a 3 week KD feeding regimen affected the main components of the sympathoadrenal counterregulatory response: adrenal sympathetic nerve activity (ASNA), adrenal gland activity, plasma epinephrine, and brainstem glucose-responsive C1 neuronal activation in anesthetized, nondiabetic male Sprague-Dawley rats. Rats on KD had similar blood glucose (BG) levels and elevated ketone body β-hydroxybutyrate (BHB) levels compared to the control Chow diet group. All KD rats responded to hypoglycemia with a robust increase in ASNA, which was initiated at significantly lower BG levels compared to Chow-fed rats. The delay in hypoglycemia-induced ASNA increase was concurrent with rapid disappearance of BHB from cerebral and peripheral circulation. Adrenal gland activity paralleled epinephrine and ASNA response. Overall, KD-induced ketosis was associated with initiation of the sympathoadrenal response at lower blood glucose levels; however, the magnitude of the response was not diminished.
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38
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Rathsman B, Haas J, Persson M, Ludvigsson J, Svensson A, Lind M, Andersson Franko M, Nyström T. LDL cholesterol level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes mellitus: A nationwide cohort study. J Intern Med 2021; 289:873-886. [PMID: 33283333 PMCID: PMC8247303 DOI: 10.1111/joim.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Microvascular complications are common in people with diabetes, where poor glycaemic control is the major contributor. The aim of this study was to explore the association between elevated LDL cholesterol levels and the risk of retinopathy or nephropathy in young individuals with type 1 diabetes. METHODS This was a nationwide observational population-based cohort study, including all children and adults with a duration of type 1 diabetes of ≤ 10 years, identified in the Swedish National Diabetes Register between 1998 and 2017. We calculated the crude incidence rates with 95% confidence intervals (CIs) and used multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) of retinopathy or nephropathy in four LDL cholesterol categories: <2.6 (Reference), 2.6-3.4, 3.4-4.1 and > 4.1 mmol L-1 . RESULTS In total, 11 024/12 350 (retinopathy/nephropathy, both cohorts, respectively) children and adults (median age 21 years, female 42%) were followed up to 28 years from diagnosis until end of study. Median duration of diabetes when entering the study was 6 and 7 years in the retinopathy and nephropathy cohort, respectively. Median LDL cholesterol was 2.4 mmol L-1 , and median HbA1c level was 61 mmol mol-1 (7.7 %). After multivariable adjustment, the HRs (95% CI) for retinopathy in individuals with LDL cholesterol levels of 2.6-3.4, 3.4-4.1 or > 4.1 mmol L-1 were as follows: 1.13 (1.03-1.23), 1.16 (1.02-1.32) and 1.18 (0.99-1.41), compared with the reference. The corresponding numbers for nephropathy were as follows: 1.15 (0.96-1.32), 1.30 (1.03-1.65) and 1.41 (1.06-1.89). CONCLUSIONS Young individuals with type 1 diabetes exposed to high LDL cholesterol levels have an increased risk of retinopathy and nephropathy independent of glycaemia and other identified risk factors for vascular complications.
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Affiliation(s)
- B. Rathsman
- From theDepartment of Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs’ Children and Youth HospitalStockholmSweden
| | - J. Haas
- From theDepartment of Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs’ Children and Youth HospitalStockholmSweden
| | - M. Persson
- From theDepartment of Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs’ Children and Youth HospitalStockholmSweden
- Department of MedicineClinical Epidemiological UnitKarolinska InstitutetStockholmSweden
| | - J. Ludvigsson
- Division of PaediatricsDepartment of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
- Crown Princess Victoria Children’s HospitalLinköpingSweden
| | - A.‐M. Svensson
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
- Centre of Registers in Region Västra GötalandGothenburgSweden
| | - M. Lind
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU Hospital GroupUddevallaSweden
| | - M. Andersson Franko
- From theDepartment of Clinical Science and EducationKarolinska InstitutetStockholmSweden
| | - T. Nyström
- From theDepartment of Clinical Science and EducationKarolinska InstitutetStockholmSweden
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Cardiovascular Disease in Type 1 Diabetes Mellitus: Epidemiology and Management of Cardiovascular Risk. J Clin Med 2021; 10:jcm10081798. [PMID: 33924265 PMCID: PMC8074744 DOI: 10.3390/jcm10081798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control. The underlying mechanisms remain poorly understood and known risk factors seem to operate differently in T1DM and type 2 diabetes mellitus (T2DM) patients. However, evidence of cardiovascular risk assessment and management in T1DM patients often is extrapolated from studies on T2DM patients or the general population. In this review, we examine the existing literature about the prevalence of clinical and subclinical CVD, as well as current knowledge about potential risk factors involved in the development and progression of atherosclerosis in T1DM patients. We also discuss current approaches to the stratification and therapeutic management of CVR in T1DM patients. Chronic hyperglycemia plays an important role, but it is likely that other potential factors are involved in increased atherosclerosis and CVD in T1DM patients. Evidence on the estimation of 10-year and lifetime risk of CVD, as well as the efficiency and age at which current cardiovascular medications should be initiated in young T1DM patients, is very limited and clearly insufficient to establish evidence-based therapeutic approaches to CVD management.
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40
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Wang Y, Zeng Z, Ding J, Yuan R, Wang R, Zhang Y, Bai L, Yu H, Tang J. Fear of hypoglycaemia among patients with type 2 diabetes mellitus: a cross-sectional study. Sci Rep 2021; 11:7971. [PMID: 33846441 PMCID: PMC8042064 DOI: 10.1038/s41598-021-86954-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
To investigate the fear of hypoglycaemia in patients with type 2 diabetes mellitus (T2DM), to identify factors related to this fear, and thus to provide evidence for clinical assessment. A total of 385 patients with T2DM who were admitted to the departments of endocrinology in five tertiary grade-A hospitals in Chongqing, China were included in this study. A questionnaire for general information and a Chinese version of Hypoglycemia Fear Survey (HFS) were used to collect the data. The average total score on the HFS was 71.67 ± 17.06 (HFS-W was 38.15 ± 10.57; HFS-B was 33.52 ± 9.54).The three items with the highest average score for HFS-W were not recognising low blood glucose (BG), not having food available, experiencing a hypoglycaemic episode alone, and for HFS-B were eating large amount of snacks, measuring BG six or more times per day, and keeping BG > 150 mmol/L. Regressions showed that number of hospitalisations for T2DM, receiving health education on diabetes, age and hypoglycaemia history because of T2DM were associated with fear of hypoglycaemia (all p < 0.05). Fear of hypoglycaemia in hospitalised patients with T2DM was strongly associated with diabetes health education, hospitalisation for diabetes, age, and hypoglycaemia history. Medical professionals should attach importance to the specific psychological interventions, health education on diabetes and the early prevention of hypoglycaemia or diabetic complications for patients with T2DM to reduce the fear of hypoglycaemia and improve their health status.
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Affiliation(s)
- Yanhao Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 98 XiWu Road, Xi'an, 710004, Shaanxi, China.,Department of Orthodontics, Xi'an Jiaotong University School of Stomatology, 98# Xiwu Road, Xi'an, 710000, Shaanxi, China.,College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Zihuan Zeng
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Jie Ding
- School of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Ruizhu Yuan
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Ruiding Wang
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - You Zhang
- School of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Liyao Bai
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Huan Yu
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China
| | - Jiao Tang
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China.
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Wu N, Bredin SSD, Jamnik VK, Koehle MS, Guan Y, Shellington EM, Li Y, Li J, Warburton DER. Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes mellitus: a cross-sectional study. Cardiovasc Diabetol 2021; 20:62. [PMID: 33712025 PMCID: PMC7955612 DOI: 10.1186/s12933-021-01255-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM. METHODS This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses. RESULTS Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25-75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1 p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00-124.14) vs (53.19 (35.68-63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74-16.22) vs 8.56 (6.18-10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (β = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (β = - 0.001, p = 0.018, model R2 = 0.205) and METs (β = - 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (β = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM. CONCLUSIONS Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.
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Affiliation(s)
- Nana Wu
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC, Canada
| | - Shannon S D Bredin
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC, Canada
| | - Veronica K Jamnik
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Michael S Koehle
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Yanfei Guan
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC, Canada
| | - Erin M Shellington
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC, Canada
| | - Yongfeng Li
- College of Sports and Health, Shandong Sport University, Ji'nan, Shandong, China
| | - Jun Li
- School of Sport Social Science, Shandong Sport University, Ji'nan, Shandong, China
| | - Darren E R Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC, Canada.
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Gómez-Peralta F, Menéndez E, Conde S, Conget I, Novials A. Clinical characteristics and management of type 1 diabetes in Spain. The SED1 study. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00003-3. [PMID: 33664001 DOI: 10.1016/j.endinu.2020.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the sociodemographic and clinical profile of a representative sample of people with type 1 diabetes mellitus (DM1) in Spain and identify factors associated with glycemic control. MATERIAL AND METHODS A cross-sectional observational study was carried out in adults and children with DM1 treated in 75 Spanish public hospitals, geographically distributed in order to be representative of the Spanish population. Within each center, the patients were included on a consecutive basis as they visited the clinic. They were interviewed, and their clinical histories were reviewed. A descriptive statistical analysis was made, and factors associated with HbA1c were analyzed using multivariate linear regression analysis. RESULTS A total of 647 patients were included: 55.3% females, aged 36.6±14.4 years, 97.2% Caucasians, BMI 24.7±4.4kg/m2 (12.1% ≥30kg/m2), and 74.0% had secondary / university education. A total of 20.2% were active smokers. The mean time from the diagnosis of DM1 was 17.9±12.0 years. A total of 48.7% presented comorbidities: 19.3% retinopathy and 16.4% hypothyroidism. As regards treatment for DM1, 76.5% received basal-bolus insulin therapy and 20.7% continuous subcutaneous insulin infusion (CSII); 51.0% of the patients used an insulin/carbohydrate ratio (ICR), with 4.6±1.6 self-monitored capillary blood glucose (SMCBG) measurements a day, and 24.8% used continuous glucose monitoring (CGM). The mean HbA1c value was 7.6±1.1% (30% below 7%). Metabolic control improved (lower HbA1c) with more daily SMCBG (B=-0.053; p=0.009), a higher educational level (B=0.461; P<0.001), greater number of hypoglycemia episodes (B=-0.253; P=0.018) and carbohydrate counting (B=-0.190; P=0.048), and worsened the longer the duration of the disease (B=0.010; P=0.010), higher total dose of insulin (B=0.010; P<0.0001), poorer adherence to diet (B=0.650; P<0.0001) and a family history of DM (B=-0.233; P=0.007). CONCLUSIONS The management of patients with DM1 in Spain, as well as the treatment they receive, is similar to that seen in other Western countries. Blood glucose control is associated with educational level, disease duration, and the characteristics of treatment and self-care.
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Affiliation(s)
| | - Edelmiro Menéndez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central Asturias, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, España
| | | | - Ignacio Conget
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red sobre Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, España
| | - Anna Novials
- Unidad de Endocrinología y Nutrición, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, España
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Kuwabara R, Hu S, Smink AM, Orive G, Lakey JRT, de Vos P. Applying Immunomodulation to Promote Longevity of Immunoisolated Pancreatic Islet Grafts. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:129-140. [PMID: 33397201 DOI: 10.1089/ten.teb.2020.0326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Islet transplantation is a promising therapy for insulin-dependent diabetes, but large-scale application is hampered by the lack of a consistent source of insulin-producing cells and need for lifelong administration of immunosuppressive drugs, which are associated with severe side effects. To avoid chronic immunosuppression, islet grafts can be enveloped in immunoisolating polymeric membranes. These immunoisolating polymeric membranes protect islet grafts from cell-mediated rejection while allowing diffusion of oxygen, nutrients, and insulin. Although clinical trials have shown the safety and feasibility of encapsulated islets to control glucose homeostasis, the strategy does up till now not support long-term graft survival. This partly can be explained by a significant loss of insulin-producing cells in the immediate period after implantation. The loss can be prevented by combining immunoisolation with immunomodulation, such as combined administration of immunomodulating cytokines or coencapsulation of immunomodulating cell types such as regulatory T cells, mesenchymal stem cells, or Sertoli cells. Also, administration of specific antibodies or apoptotic donor leucocytes is considered to create a tolerant microenvironment around immunoisolated grafts. In this review, we describe the outcomes and limitations of these approaches, as well as the recent progress in immunoisolating devices. Impact statement Immunoisolation by enveloping islets in semipermeable membranes allows for successful transplantation of islet grafts in the absence of chronic immunosuppression, but the duration of graft survival is still not permanent. The reasons for long-term final graft failure is not fully understood, but combining immunoisolation with immunomodulation of tissues or host immune system has been proposed to enhance the longevity of grafts. This article reviews the recent progress and challenges of immunoisolation, as well as the benefits and feasibility of combining encapsulation approaches with immunomodulation to promote longevity of encapsulated grafts.
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Affiliation(s)
- Rei Kuwabara
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shuxian Hu
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexandra M Smink
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Jonathan R T Lakey
- Department of Surgery and Biomedical Engineering, University of California Irvine, Irvine, California, USA
| | - Paul de Vos
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ghandi K, Pieri B, Dornhorst A, Hussain S. A Comparison of Validated Methods Used to Assess Impaired Awareness of Hypoglycaemia in Type 1 Diabetes: An Observational Study. Diabetes Ther 2021; 12:441-451. [PMID: 33219468 PMCID: PMC7843675 DOI: 10.1007/s13300-020-00965-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/30/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Clarke, Gold and Pedersen are validated methods to assess awareness of hypoglycaemia. Identifying impaired awareness of hypoglycaemia (IAH) is critical for supporting people with structured education and diabetes technologies, to reduce harm of hypoglycaemia. This study compares the Clarke score, Gold score and Pedersen methods and their correlations with features of hypoglycaemia unawareness and patient characteristics, to evaluate the accuracy of the methods in identifying IAH. METHODS This retrospective, observational questionnaire-based study collected routine clinical data from 100 people with type 1 diabetes. The questionnaire included the three validated scoring methods, frequency of severe and nocturnal hypoglycaemia, knowledge and worry of hypoglycaemia and hypoglycaemia symptom scores using the Edinburgh Hypoglycaemia Scale. Data were analysed for IAH prevalence and the associations with features of IAH. The concordance of Clarke, Gold and Pedersen methods was evaluated using Spearman's correlation coefficient. RESULTS The prevalence of IAH in this cohort identified by Clarke, Gold and Pedersen methods was 18%, 19% and 61% respectively. The mean autonomic symptom score in people with IAH was significantly reduced using the Clarke method (P = 0.0002) but not on Gold (P = 0.12) and Pedersen methods (P = 0.79). For people with IAH assessed using the Clarke method, scores for night-time worry regarding hypoglycaemia (P = 0.04) and self-reported frequency of nocturnal hypoglycaemia (P = 0.001) were increased. Spearman's correlation coefficients between Pedersen and Clarke and Pedersen and Gold were Rs = 0.555 (P < 0.001) and Rs = 0.645 (P < 0.001) respectively. A moderate association was observed between Clarke and Gold Rs = 0.5669 (P < 0.001). CONCLUSION Whilst Clarke and Gold methods determined a similar prevalence of IAH, people identified with IAH assessed by the Clarke method had a significant association with the features and characteristics of IAH, including reduced autonomic symptoms. This study suggests that performing more than one score is important for a reliable risk assessment of IAH.
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Affiliation(s)
- Kshitiz Ghandi
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Beatrice Pieri
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Anne Dornhorst
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Sufyan Hussain
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK.
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Cardiovascular disease in type 1 diabetes: A review of epidemiological data and underlying mechanisms. DIABETES & METABOLISM 2020; 46:442-449. [PMID: 32998054 DOI: 10.1016/j.diabet.2020.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 12/15/2022]
Abstract
Cardiovascular disease (CVD) is highly prevalent in patients with type 1 diabetes (T1D) and a major cause of mortality. CVD arises earlier in life in T1D patients and is responsible for a significant reduction of at least 11 years' life expectancy. Also, the incidence of CVD is much more pronounced in patients with T1D onset at an earlier age. However, the factors responsible for increased atherosclerosis and CVD in T1D are not yet totally clarified. In addition to the usual cardiovascular (CV) risk factors, chronic hyperglycaemia plays an important role by promoting oxidative stress, vascular inflammation, monocyte adhesion, arterial wall thickening and endothelial dysfunction. Diabetic nephropathy and cardiac autonomic neuropathy are also associated with increased CVD in T1D. In fact, the CVD risk remains significantly increased even in well-controlled T1D patients who have no additional CV risk factors, indicating that other potential factors are likely to be involved. Hypoglycemia and glucose variability could enhance CV disease by promoting oxidative stress, vascular inflammation and endothelial dysfunction. Furthermore, even well-controlled T1D patients show significant qualitative and functional abnormalities of lipoproteins that are likely to be implicated in the development of atherosclerosis and premature CVD. In addition, recent data suggest that a dysfunctional immune system, which is typical of autoimmune T1D, might also promote CVD possibly through inflammatory pathways. Moreover, overweight and obese T1D patients can manifest additional CV risk through pathophysiological mechanisms resembling those observed in type 2 diabetes (T2D).
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O'Reilly JE, Blackbourn LAK, Caparrotta TM, Jeyam A, Kennon B, Leese GP, Lindsay RS, McCrimmon RJ, McGurnaghan SJ, McKeigue PM, McKnight JA, Petrie JR, Philip S, Sattar N, Wild SH, Colhoun HM. Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017. Diabetologia 2020; 63:1626-1636. [PMID: 32451572 PMCID: PMC7351819 DOI: 10.1007/s00125-020-05173-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/01/2020] [Indexed: 02/04/2023]
Abstract
AIMS/HYPOTHESIS We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. METHODS Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). RESULTS There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). CONCLUSIONS/INTERPRETATION Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia. Graphical abstract.
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Affiliation(s)
- Joseph E O'Reilly
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XUT, UK
| | - Luke A K Blackbourn
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XUT, UK
| | - Thomas M Caparrotta
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XUT, UK
| | - Anita Jeyam
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XUT, UK
| | - Brian Kennon
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Stuart J McGurnaghan
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XUT, UK
| | - Paul M McKeigue
- Usher Institute of Population Health Sciences and Informatics, Centre for Population Health Sciences, School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sam Philip
- Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, Centre for Population Health Sciences, School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XUT, UK.
- Public Health, NHS Fife, Kirkcaldy, UK.
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Zahed K, Sasangohar F, Mehta R, Erraguntla M, Qaraqe K. Diabetes Management Experience and the State of Hypoglycemia: National Online Survey Study. JMIR Diabetes 2020; 5:e17890. [PMID: 32442145 PMCID: PMC7330735 DOI: 10.2196/17890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hypoglycemia, or low blood sugar levels, in people with diabetes can be a serious life-threatening condition, and serious outcomes can be avoided if low levels of blood sugar are proactively detected. Although technologies exist to detect the onset of hypoglycemia, they are invasive or costly or exhibit a high incidence of false alarms. Tremors are commonly reported symptoms of hypoglycemia and may be used to detect hypoglycemic events, yet their onset is not well researched or understood. OBJECTIVE This study aimed to understand diabetic patients' perceptions of hypoglycemic tremors, as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool to ultimately inform the design of a noninvasive and cost-effective technology that detects tremors associated with hypoglycemia. METHODS A cross-sectional internet panel survey was administered to adult patients with type 1 diabetes using the Qualtrics platform in May 2019. The questions focused on 3 main constructs: (1) perceived experiences of hypoglycemia, (2) experiences and expectations about a diabetes management device and mobile app, and (3) beliefs and attitudes regarding intention to use a diabetes management device. The analysis in this paper focuses on the first two constructs. Nonparametric tests were used to analyze the Likert scale data, with a Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity. RESULTS Data from 212 respondents (129 [60.8%] females) revealed statistically significant differences in perceived noticeability of tremors by gender, whereby males noticed their tremors more (P<.001), and age, with the older population reporting lower noticeability than the young and middle age groups (P<.001). Individuals living longer with diabetes noticed their tremors significantly less than those with diabetes for ≤1 year but not in terms of frequency or severity. Additionally, the majority of our participants (150/212, 70.7%) reported experience with diabetes-monitoring devices. CONCLUSIONS Our findings support the need for cost-efficient and noninvasive continuous monitoring technologies. Although hypoglycemic tremors were perceived to occur frequently, such tremors were not found to be severe compared with other symptoms such as sweating, which was the highest rated symptom in our study. Using a combination of tremor and galvanic skin response sensors may show promise in detecting the onset of hypoglycemic events.
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Affiliation(s)
- Karim Zahed
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Ranjana Mehta
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Madhav Erraguntla
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Khalid Qaraqe
- Department of Electrical and Computer Engineering, Texas A&M University at Qatar, Doha, Qatar
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Tsunemi A, Sato J, Kurita M, Wakabayashi Y, Waseda N, Koshibu M, Shinohara M, Ozaki A, Nakamura H, Hirano N, Ikeda F, Satoh H, Watada H. Effect of real-life insulin pump with predictive low-glucose management use for 3 months: Analysis of the patients treated in a Japanese center. J Diabetes Investig 2020; 11:1564-1569. [PMID: 32374513 PMCID: PMC7610121 DOI: 10.1111/jdi.13288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction In Japan, an insulin pump with predictive low‐glucose management (PLGM) was launched in 2018. It automatically suspends insulin delivery when the sensor detects or predicts low glucose values. The aim of this study was to analyze the safety and efficacy of PLGM in patients treated in a Japanese center. Materials and Methods We carried out a retrospective observational analysis of 16 patients with type 1 diabetes mellitus and one patient after pancreatectomy. They switched from the MiniMed 620G device to the 640G device with PLGM. The primary outcome was the change in the percentage of time in hypoglycemia. The secondary outcome was the change in HbA1c (%) over a period of 3 months. We also explored the presence of “post‐suspend hyperglycemia” with the 640G device. Results After changing to the 640G device, the percentage of time in hypoglycemia (glucose <50 mg/dL) significantly decreased from 0.39% (0–1.51%) to 0% (0–0.44%; P = 0.0407). The percentage of time in hyperglycemia (glucose >180 mg/dL) significantly increased from 25.53% (15.78–44.14%) to 32.9% (24.71–45.49%; P = 0.0373). HbA1c significantly increased from 7.6 ± 1.0% to 7.8 ± 1.1% (P = 0.0161). From 1.5 to 4.5 h after the resumption of insulin delivery, the percentage of time in hyperglycemia was 32.23% (24.2–53.75%), but it was significantly lower, 2.78% (0–21.6%), when patients manually restarted the pump within 30 min compared with automatic resumption 31.2% (20–61.66%; P = 0.0063). Conclusions Predictive low‐glucose management is an effective tool for reducing hypoglycemia, but possibly elicits “post‐suspend hyperglycemia.” This information is useful for achieving better blood glucose control in the patients treated with PLGM.
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Affiliation(s)
- Asako Tsunemi
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Junko Sato
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mika Kurita
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuka Wakabayashi
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoko Waseda
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mami Koshibu
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mai Shinohara
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Ozaki
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromi Nakamura
- Department of Nursing, Juntendo University Hospital, Tokyo, Japan
| | - Naomi Hirano
- Department of Nursing, Juntendo University Hospital, Tokyo, Japan
| | - Fuki Ikeda
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Satoh
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Center for Identification of Diabetic Therapeutic Targets, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Kane P, Larsen P, Wiltshire E. Early identification of cardiac autonomic neuropathy using complexity analysis in children with type 1 diabetes. J Paediatr Child Health 2020; 56:786-790. [PMID: 31883287 DOI: 10.1111/jpc.14745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022]
Abstract
AIM In children and adolescents, there are significant limitations to detecting cardiac autonomic neuropathy (CAN), an important contributor to morbidity and mortality in adults with type 1 diabetes (T1D). The analysis of heart rate variability (HRV) is one method available to detect CAN. Some evidence shows traditional linear HRV measures detect abnormalities in youth with T1D. In this study, we aimed to assess whether non-linear complexity analysis of HRV would assist identification of CAN in youth with T1D and to assess contributory factors. METHODS We studied 19 youth with T1D and 17 healthy controls. Each had an electrocardiogram recorded continuously for 10 min, at a sampling frequency of 1000 Hz. Using Labview software and an algorithm for complexity analysis, along with standard time-domain and spectral analysis, recordings of the electrocardiogram were analysed to detect differences in HRV between groups. RESULTS Youth with T1D had significantly higher sample entropy than controls (P = 0.015) suggesting increased complexity in HRV, but similar detrended fluctuation analysis (P = 0.68). Youth with T1D also had increased % high frequency power (P = 0.017) and reduced mid-frequency power (P = 0.019) on spectral analysis. There were no differences in heart rate or blood pressure responses to standing, or time-domain analysis of HRV. Within the T1D group, sample entropy correlated strongly with triglycerides (r = 0.76, P = 0.001) and detrended fluctuation analysis correlated strongly with serum potassium (r = -0.86, P < 0.001). CONCLUSIONS Complexity analysis of HRV, particularly using sample entropy, may aid detection of CAN in youth with T1D.
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Affiliation(s)
- Penny Kane
- Department of Paediatrics and Child Health, Capital and Coast District Health Board, Wellington, New Zealand
| | - Peter Larsen
- Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
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50
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Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes. ACTA ACUST UNITED AC 2020; 68:47-52. [PMID: 32349942 DOI: 10.1016/j.endinu.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.
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