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Canha M, Ferreira S, Santos Silva R, Azevedo A, Rodrigues AS, Castro-Correia C. Glycemic Control and Metabolic Parameters in Children and Adolescents With Type 1 Diabetes. Cureus 2023; 15:e43416. [PMID: 37706129 PMCID: PMC10496859 DOI: 10.7759/cureus.43416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/15/2023] Open
Abstract
AIM The association between glycemic control and metabolic status is poorly defined in children and adolescents with T1D, besides being biologically plausible. We aimed to evaluate the association between glycemic control and body mass index (BMI), blood pressure (BP), and lipid profile in children and adolescents with T1D. METHODS Observational cross-sectional study including children and adolescents (5-18 years old) followed in our outpatient clinic with the diagnosis of T1D for at least a year. We used linear regression models (unadjusted and adjusted to sex and age) to evaluate the association between glycated hemoglobin (A1c) and time in range (TIR), several prespecified metabolic parameters, and prespecified demographic and clinical characteristics. We considered a p-value of <0.05 to be statistically significant. RESULTS A total of 144 patients were included, 51% of whom were female. The population had a mean age of 12.7±3.4 years old. We report a positive association between A1c and BMI, systolic and diastolic BP, total- and LDL-cholesterol and triglycerides. Females and patients diagnosed at a younger age presented with higher A1c values. There is a tendency for a negative association between TIR and the former parameters. Higher A1c levels and lower TIR were associated with higher glycemic variability and were treated with a higher basal insulin per Kg dose. CONCLUSION Our results support an important association between worse glycemic control and an unhealthier metabolic profile in children and adolescents with T1D. We can hypothesize that a good glycemic profile is needed to achieve good metabolic control at a young age.
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Affiliation(s)
- Marta Canha
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário São joão, Porto, PRT
| | - Sofia Ferreira
- Pediatric Endocrinology and Diabetology Unit, Centro Hospitalar Universitário São joão, Porto, PRT
| | - Rita Santos Silva
- Pediatric Endocrinology and Diabetology Unit, Centro Hospitalar Universitário São joão, Porto, PRT
| | - Aida Azevedo
- Pediatrics, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
| | - Ana S Rodrigues
- Paediatrics, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
| | - Cintia Castro-Correia
- Pediatric Endocrinology and Diabetology Unit, Centro Hospitalar Universitário São joão, Porto, PRT
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Matheus ASM, Pascoal JBF, Cabizuca CA, Tannus LRM, Guimarães RS, Mattos DMF, Cobas RA. Flash glucose monitoring system in patients with type 1 diabetes in healthcare center in Brazil: real world data from a short-term prospective study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 67:289-297. [PMID: 36468924 DOI: 10.20945/2359-3997000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D). Materials and methods Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (|FGMi - SMBGi|) / SMBGi, where it was a paired data sample. Results In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively. Conclusion FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.
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3
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Taniguchi H, Nirengi S, Ishihara K, Sakane N. Association of serum fibroblast growth factor 21 with diabetic complications and insulin dose in patients with type 1 diabetes mellitus. PLoS One 2022; 17:e0263774. [PMID: 35192641 PMCID: PMC8863253 DOI: 10.1371/journal.pone.0263774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Fibroblast growth factor (FGF) 21 is an important regulator of glycemic control, but the association between circulating FGF21 and diabetic complications is poorly understood. Moreover, basal FGF21 secretion, especially in response to insulin dose, in patients with type 1 diabetes mellitus (T1DM), has not been well examined. Therefore, this study aimed to determine the association of circulating FGF21 levels with diabetic complications and insulin dosage in middle-aged and elderly patients with T1DM. Materials and methods A total of 127 middle-aged and elderly patients with T1DM, including 68 patients with diabetic complications, and 106 non-diabetic individuals were analyzed in this cross-sectional study. Information on demographic characteristics and T1DM was extracted from their electronic medical records. Serum FGF21 levels were determined using ELISA. Results Serum FGF21 levels were significantly lower in T1DM patients (75.2 [37.4–135.1] pg/mL) than in non-diabetic participants (151.6 [92.0–224.6] pg/mL; P < 0.001). No diabetic complications were associated with serum FGF21 concentrations. Both basal and bolus insulin doses were significantly and positively correlated with serum FGF21 levels (P < 0.05). Stepwise multiple regression analysis showed that FGF21 level was associated with age and body mass index (P < 0.05), while the basal insulin dose was an independent positive predictor of serum FGF21 levels (β = 0.197, P = 0.032). Conclusions Circulating FGF21 levels are reduced in patients with T1DM; however, they are not associated with diabetic complications. In addition, aging, obesity, and insulin dosage are positive determinants of circulating FGF21.
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Affiliation(s)
- Hirokazu Taniguchi
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
- Faculty of Agriculture, Ryukoku University, Shiga, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Kengo Ishihara
- Faculty of Agriculture, Ryukoku University, Shiga, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- * E-mail:
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4
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Maahs DM, Ekhlaspour L, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2021; 23:S113-S130. [PMID: 34061625 PMCID: PMC8881949 DOI: 10.1089/dia.2021.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Laya Ekhlaspour
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Tumini S, Iacono O, Comegna L, Fioretti E, Guidone P, Levantini G, Panichi D, Catenaro M, Rossi I, Amaro F, Graziano G, Rossi MC, Cipriano P. Insulin/carbohydrates ratio during the first 6-month therapy with insulin degludec in a paediatric population with type 1 diabetes previously treated with insulin glargine. An observational longitudinal study. Endocrinol Diabetes Metab 2020; 3:e00121. [PMID: 32318639 PMCID: PMC7170455 DOI: 10.1002/edm2.121] [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: 12/19/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND No data exist about the changes induced by the transition from first-generation long-acting insulins to second-generation long-acting analogues in the paediatric population. OBJECTIVE To assess changes in insulin/carbohydrate ratio (I:CHO) after the first 6 months of degludec therapy in a paediatric population with type 1 diabetes previously treated with glargine U100. SUBJECTS All patients treated with degludec under routine clinical practice conditions were retrospectively analysed. METHODS Nonprofit observational retrospective study. Changes during the follow-up in mean CHO/I ratio were assessed using longitudinal linear models for repeated measures. Rate of hypoglycaemia, ketoacidosis and adverse events was evaluated. RESULTS Overall, 51 children (mean age 13.8 ± 4.6 years; mean diabetes duration 5.8 ± 3.9 years) started therapy with degludec in the period between April 2017 and April 2018. I:CHO ratio before starting degludec therapy significantly differed among the three meals, being the lowest at breakfast and the highest at dinner. After introducing degludec, I:CHO ratio at lunch (-1.29 95% CI -2.02;-0.57) and at dinner (-3.08 95% CI -4.35;-1.8) significantly decreased, while it slightly increased at breakfast (+1.37 95% CI 0.47;2.28). No episodes of severe hypoglycaemia, ketoacidosis and adverse event were recorded during 6 months. CONCLUSIONS Our data show that the use of degludec is associated with a significant change in the I:CHO ratio at the different meals compared to the previous glargine therapy. This could derive from the flat and prolonged pharmacokinetic profile of degludec. This has important clinical implications for daily insulin dose adjustments.
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Affiliation(s)
| | | | - Laura Comegna
- Department of PediatricsUniversity of ChietiChietiItaly
| | | | - Paola Guidone
- Department of PediatricsUniversity of ChietiChietiItaly
| | | | | | | | - Ilaria Rossi
- Department of PediatricsUniversity of ChietiChietiItaly
| | - Flavia Amaro
- Department of PediatricsUniversity of ChietiChietiItaly
| | - Giusi Graziano
- CORESEARCH – Center for Outcomes Research and Clinical EpidemiologyPescaraItaly
| | - Maria Chiara Rossi
- CORESEARCH – Center for Outcomes Research and Clinical EpidemiologyPescaraItaly
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Proportion of Basal to Total Insulin Dose Is Associated with Metabolic Control, Body Mass Index, and Treatment Modality in Children with Type 1 Diabetes-A Cross-Sectional Study with Data from the International SWEET Registry. J Pediatr 2019; 215:216-222.e1. [PMID: 31345576 DOI: 10.1016/j.jpeds.2019.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To investigate in a large population the proportion of daily basal insulin dose (BD) to daily total insulin dose (TD) (BD/TD) and its association with glycated hemoglobin A1c (HbA1c), body mass index (BMI)- SDS, and treatment modality in children with type 1 diabetes. STUDY DESIGN Cross-sectional study in subjects with type 1 diabetes, age ≤18 years, and ≥2 years of diabetes duration, registered in the international multicenter Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference registry in March 2018. Variables included region, sex, age, diabetes duration, treatment modality (multiple daily injections [MDI] or continuous subcutaneous insulin infusion [CSII]), self-monitoring blood glucose, HbA1c, BD/TD, and BMI-SDS. BMI was converted to BMI-SDS using World Health Organization charts as reference. Hierarchic linear regression models were applied with adjustment for age, sex, and diabetes duration. RESULTS A total of 19 687 children with type 1 diabetes (49% female, 49% CSII users) with median age 14.8 (11.5; 17.2) years and diabetes duration 6.0 (3.9; 9.0) years were included. HbA1c was 63 (55; 74) mmol/mol (7.9 [7.2; 8.9]%), and BMI-SDS 0.55 (-0.13; 1.21). Unadjusted, a lower BD/TD was associated with lower HbA1c, male sex, younger age, shorter diabetes duration, lower BMI-SDS, higher numbers of self-monitoring blood glucose and CSII (all P < .01). After adjustment for confounders, lower BD/TD was associated with lower HbA1c (P < .01) and lower BMI-SDS (P < .01) in children on CSII, but not on MDI. CONCLUSIONS Lower BD/TD is positively associated with lower HbA1c and lower BMI-SDS in children with type 1 diabetes on CSII. It remains to be investigated in a prospective study whether reducing BD/TD insulin will improve metabolic control and normalize body weight in children with type 1 diabetes.
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Al Hayek AA, Robert AA, Al Dawish MA. Differences of FreeStyle Libre Flash Glucose Monitoring System and Finger Pricks on Clinical Characteristics and Glucose Monitoring Satisfactions in Type 1 Diabetes Using Insulin Pump. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2019; 12:1179551419861102. [PMID: 31308786 PMCID: PMC6604122 DOI: 10.1177/1179551419861102] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022]
Abstract
Background: To evaluate the different experience of freestyle libre and finger pricks on
clinical characteristics and glucose monitoring satisfaction (GMS) in
patients with type 1 diabetes (T1D) using insulin pump (IP). Methods: A prospective study was carried out on 47 (aged 17-21 years) T1D, who used
conventional finger-pricking method for self-testing the glucose. The
experiments were conducted between March 2018 and September 2018. For
carrying out the study, the flash glucose monitoring (FGM) sensors were
placed on each participant, at the baseline visit, by a trained diabetes
educator. Furthermore, to determine the total number of scans conducted
during the study period, the respective ambulatory glucose profiles were
generated by computing the data collected from the sensors. In addition, a
trained interviewer handed over the GMS questionnaire to each patient, at
the baseline and at 12 weeks of the study. Results: In comparison to the baseline (finger pricks), various parameters such as:
HbA1c (P = .042), hypoglycemia (P = .001),
mean capillary glucose (P = .004), total daily insulin dose
(P = .0001), percentage of bolus insulin
(P = .0001), daily bolus frequency
(P = .0001), and daily carbohydrates intake
(P = .0001) showed a significant improvement at
12 weeks. Similarly, substantial augmentation was noticed, in the sub
domains of GMS, that is, openness (P = .0001), emotional
burden (P = .0001), behavioral burden
(P = .0001), and trust (P = .0001) at
12 weeks as compared to baseline. Overall, total GMS score at baseline was
1.72 ± 0.37, which increased up to 3.41 ± 0.49 (P = .0001)
in the time period of 12 weeks. The HbA1c (r2 = 0.45),
hypoglycemia (r2 = 0.58), and the mean number of FGM scans,
exhibited a negative correlation, while GMS (r2 = 0.52) and the
mean number of FGM scans, exhibited a positive correlation. Conclusion: The frequency of hypoglycemia, HbA1c level, capillary glucose, daily
carbohydrates intake decreased, while the total daily insulin dose, daily
bolus insulin and total GMS score increased with the use of FGM scanning for
12 weeks.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asirvatham A Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience. Adv Med 2018; 2018:1473160. [PMID: 29974056 PMCID: PMC6008663 DOI: 10.1155/2018/1473160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/09/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. MATERIALS AND METHODS We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland. Data were downloaded from patients' pumps and collected from medical records. We analyzed the settings of BI and the association of %BI with HbA1c level. Linear regression was performed. RESULTS The mean age of T1DM individuals was 26.6 ± 8.2 years, BMI was 23.1 ± 3.0 kg/m2, T1DM duration was 13.3 ± 6.4 years, and HbA1c level was 7.4%. There were 69.6% (n=181) of T1DM patients with %BI in the recommended range. The T1DM duration and HbA1c level of patients with a %BI <30% (n=23) was 9.5 years and 6.4%, respectively; for a %BI of 30-50%, it was 13.2 years and 7.4%; and for a %BI >50% (n=56), it was 15.8 years and 7.8% (p < 0.001 for both three-group comparisons). Multiple regression identified %BI among independent predictors of the HbA1c level. CONCLUSION In this real-life analysis, the recommendations concerning %BI dosing were not followed by almost one-third of adult T1DM patients. Low %BI was associated with better glycemic control; however, this requires further confirmation.
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