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

Antheraea pernyi silk nanofibrils with inherent RGD motifs accelerate diabetic wound healing: A novel drug-free strategy to promote hemostasis, regulate immunity and improve re-epithelization

The chronic inflammation and matrix metalloprotease (MMP)-induced tissue degradation significantly disrupt re-epithelization and delay the healing process of diabetic wounds. To address these issues, we produced nanofibrils from Antheraea pernyi (Ap) silk fibers via a facile and green treatment of swelling and shearing. The integrin receptors on the cytomembrane could specifically bind to the Ap nanofibrils (ApNFs) due to their inherent Arg-Gly-Asp (RGD) motifs, which activated platelets to accelerate coagulation and promoted fibroblast migration, adhesion and spreading. These degradable nanofibrils served as effective competitive substrates to reduce MMP-induced tissue degradation. ApNFs and their enzymatic hydrolysates could modulate macrophage polarization due to their RGD motifs. RNA sequencing further revealed that ApNFs treatment activated the JAK2-STAT5b and PI3K-Akt signaling pathways while suppressed the NF-κB, IL-17 and TNF signaling pathways in macrophages. The full-thickness skin wound experiments confirmed that ApNFs significantly accelerated wound healing in both diabetic and non-diabetic rats. Notably, in diabetic wound, ApNFs and their enzymatic hydrolysates polarized the accumulated M1-type macrophages into M2-type, which promoted the wound to get rid of the inflammatory stage and transition to the following proliferative stage, improving the wound healing percentage on day 14 from 74.9 % to 93.2 % by facilitating collagen deposition, angiogenesis and re-epithelization. These results demonstrate that ApNFs are promising drug-free diabetic wound dressings with favorable inherent immunoregulatory properties for biomedical translation.

Active targeting of type 1 diabetes therapies to pancreatic beta cells using nanocarriers

Type 1 diabetes is an autoimmune disease characterised by the destruction of pancreatic beta cells, resulting in lifelong insulin dependence. Although exogenous insulin can maintain glycaemic control, this approach does not protect residual or replacement pancreatic beta cells from immune-mediated death. Current therapeutics designed to protect functional beta cell mass or promote beta cell proliferation and regeneration can have off-target effects, resulting in higher dose requirements and adverse side effects. Targeted drug delivery using nanocarriers has demonstrated potential for overcoming these limitations. The critical bottleneck limiting the development of beta cell-targeted therapies is a lack of highly specific beta cell markers. This review provides an overview of the use of nanocarriers for cell-targeted delivery and the current state of the field of beta cell targeting. Technologies such as systematic evolution of ligands by exponential enrichment (SELEX) aptamer selection, phage display screening, and omics datasets from human samples are highlighted as tools to identify novel beta cell-specific targets that can be combined with nanocarriers for targeted delivery of therapeutics. Ultimately, beta cell-targeted therapies using nanocarriers present a unique opportunity to develop tailored treatments for each stage of type 1 diabetes with the goal of providing individuals with treatment options that prevent further progression or reverse the course of the disease.

Anti-CD3 monoclonal antibody in treating patients with type 1 diabetes: an updated systematic review and meta-analysis

OBJECTIVE

To evaluate the efficacy of anti-CD3 monoclonal antibody (mAb) in patients with type 1 diabetes (T1D) and identify the influencing factors.

METHODS

Randomized controlled trials comparing anti-CD3 mAb with placebo or standard care in T1D participants were screened from PubMed, Embase, and Cochrane databases until 31 May 2024. Changes in area under the curve (AUC) of C-peptide, HbA1c level and daily insulin requirement were main outcomes. Results were computed as standardized mean difference (SMD) and 95% confidence interval (CI). Meta-regression and subgroup analyses were also performed.

RESULTS

Eleven eligible trials involving 1573 T1D participants were included in this meta-analysis. Compared with control group, anti-CD3 mAb significantly increased AUC of C-peptide (SMD = 0.337, 95% CI 0.105 to 0.569, P = 0.004) and decreased daily insulin requirement (SMD =  - 0.598, 95% CI  - 0.927 to - 0.269, P < 0.001). Subgroup analysis revealed that low average age (≤ 18 years old: SMD = 0.546, 95% CI 0.203 to 0.889, P < 0.001), high cumulative dose of anti-CD3 mAb (≥ 25 mg: SMD = 0.588, 95% CI 0.424 to 0.752, P < 0.001), and short T1D diagnosis duration before enrollment (≤ 6 weeks: SMD = 0.609, 95% CI 0.405 to 0.814, P < 0.001) were significantly associated with an increase in AUC of C-peptide. Notably, meta-regression analysis revealed that cumulative dose was the most critical factor, masking the effect of average age and T1D diagnosis duration. Most adverse events were transient and could be medically treated.

CONCLUSION

Anti-CD3 mAb effectively preserves C-peptide secretion and reduces insulin requirement in patients with T1D. Younger age (≤ 18 years), earlier treatment initiation (≤ 6 weeks post-diagnosis), higher cumulative doses (≥ 25 mg) may present better therapeutic effect.

Technology Use and Diabetes Management Across Elder Age Groups in Type 1 Diabetes and Latent Auto-Immune Diabetes of the Adult (LADA), a BETTER Registry Cross-Sectional Analysis

OBJECTIVES

Real-world data on diabetes management among a heterogenous aging population remain limited. This study aims to provide an overview of technology use and factors associated to its use, diabetes management and psychosocial aspects experienced by adults aged 50 and over living with type 1 diabetes (T1D) or latent autoimmune diabetes in adults (LADA).

METHODS

This cross-sectional study analyzed data from the Canadian BETTER registry, mostly based on self-reported outcomes from individuals living with T1D or LADA. Comparative analyses were conducted across three age groups: 50-59, 60-69, and ≥70.

RESULTS

Participants (n=674) were predominantly Caucasian (97-98% across groups) and residing in Quebec, Canada (71-79%). Insulin pump use was similar across age groups (36-39%, p=0.822), while continuous glucose monitoring (CGM) was lower among those aged ≥70 years (85% for both 50-59 and 60-69 vs 73% for ≥70 years, p=0.020). Among other factors, having private insurance and living outside of Quebec were positively associated with both insulin pump and CGM use. A high proportion (80-86%) of participants achieved an HbA1c ≤8% across all groups. Level 2 hypoglycemia events in the last month were more frequent among participants aged 50-59 years compared to those aged ≥70 years (6.9 vs 3.4, p=0.001). Level 3 hypoglycemia, social and professional support were similar between groups. Interestingly, diabetes-related distress was lower in older age groups.

CONCLUSIONS

Most individuals in this cohort adopted technology use but in lower proportion among the group aged ≥70. Overall, diabetes management was good and similar between age groups.

Association between exanthematous diseases and earlier age at Type 1 diabetes diagnosis: a Brazilian cohort study

OBJECTIVE

To assess the association between exanthematous diseases, and an earlier age at Type 1 diabetes mellitus diagnosis (T1DM) in a cohort of Brazilian patients.

METHODS

This was a retrospective cohort study including 812 patients diagnosed with T1DM in Bauru, São Paulo, Brazil, between 1981 and 2023. Data regarding sociodemographic parameters such as age, sex, ethnicity, socioeconomic status, as well as the occurrence of a previous exanthematous diseases, such as chickenpox, measles, rubella, mumps and scarlet fever were collected. An adapted survival analysis was performed to evaluate the impact of each variable on the age of T1DM diagnosis.

RESULTS

Overall, 596 patients were evaluated. Their average age at T1DM diagnosis was 12 ± 7.69 years. It was found that presenting rubella, measles, and mumps, as well as belonging to non-high socioeconomic class, were associated with 35%, 40%, 39%, and 34% lower age at T1DM diagnosis, respectively.

CONCLUSIONS

This study has found that rubella, measles, mumps, and belonging to non-high socioeconomic classes were significantly associated with earlier age at T1DM diagnosis in a cohort of Brazilian patients with T1DM. Future studies with other populations are warranted to confirm our findings.

We Are Not Alone: Examining the Impact of a Teen Diabetes Day Camp

Type 1 diabetes (T1D) is a chronic disease that influences all health aspects. The self-determination theory (SDT) suggests that three psychological needs of competence, autonomy, and relatedness are necessary for motivation to engage in healthy behaviors. Through medical specialty camps, these needs can be met by educating campers on how to manage T1D and realize they are not alone. The volunteer-based, five-day, inaugural tween-teen camp for youth with T1D was held on the campus of a university. The entire camp experience was engineered around the three basic needs described by the SDT. These needs were promoted by physical and educational activities and meeting friends. The Basic Psychological Needs and Frustration Scale was administered as a pre-, post-, and follow-up test. Two of the four measures were significant, the autonomy pretest (M = 3.93; SD = 0.75) to posttest (M = 4.49; SD = 0.56), with t(25) = -6.258; p ≤ 0.001) and relatedness pretest (M = 4.31; SD = 0.79) to posttest (M = 4.53; SD = 0.49), with t(25) = -2.168; p = 0.040; however, mean scores declined at the 3-month follow-up. Campers' blood glucose levels were collected through an online platform that allowed staff to monitor blood glucose levels, with the week's average being 150 mg/dL, and almost 71% remaining in the TIR. The results can be helpful for practitioners who want to use the SDT to structure and examine the effectiveness of medical specialty camps for youth with T1D.

Marked improvement in HbA1c following introduction of biosimilar insulin to treatment regimen of children and youth with type 1 diabetes in Mali: A randomised controlled trial

AIMS

Evidence on outcomes of treating type 1 diabetes (T1D) with long-acting basal insulins in low-resourced settings is lacking. This study aimed to evaluate the impact of switching children and youth with T1D in the low-income country of Mali from human insulin via syringe to long-acting biosimilar insulin glargine delivered by reusable pens combined with short-acting insulin via syringe.

METHODS

A two-group parallel design randomised trial was conducted enrolling 260 youth aged <25 years, diagnosed with T1D for ≥12 months without prior use of analogue insulin. Youth were randomised 1:1 to either continue receiving current therapy or switch to analogue insulin. The primary outcome was HbA1c, collected at baseline and 3-monthly for 12 months.

RESULTS

Primary outcome data were available for 130 (100%) youth in the intervention group and 128 (98.5%) in the control group. Over the 12-month study period, mean HbA1c decreased from 103 to 65 mmol/mol (11.6%-8.1%) (p < 0.001) in the intervention group and from 101 to 93 mmol/mol (11.4% to 10.7%) in the control group (p < 0.01), an absolute difference of 30 mmol/mol (95% CI: -37, -24) (p < 0.001). The proportion of participants with HbA1c ≥130 mmol/mol (≥14%) decreased from 38.5% to 0% in the intervention group, versus 40.6% to 21.9% in the control group.

CONCLUSIONS

Switching to a basal-bolus insulin regimen including biosimilar glargine resulted in marked improvements in HbA1c and diabetic ketoacidosis episodes. With relevant training, resources, and support, use of long-acting analogue insulin for treating T1D in Mali was feasible and acceptable to participants and healthcare professionals.

Young Adults with Type 1 Diabetes' Clinical Outcomes and Satisfaction Related to the Use of Videoconferencing for Type 1 Diabetes Healthcare: A Narrative Review

INTRODUCTION

Young adulthood is well documented as being a particularly challenging area of type 1 diabetes (T1D) healthcare. Many young adults with T1D (YAT1D) are distracted from effective disease self-management; T1D healthcare service engagement can be problematic and inconsistent, and high rates of unplanned healthcare contacts prevail. Video conferencing use can facilitate services to be flexible and responsive. We aimed to evaluate clinical outcomes and satisfaction related to the use of videoconferencing for T1D healthcare in YAT1D.

METHODS

A quantitative narrative review was undertaken, using a systematic process. PubMed, Scopus and CINAHL were searched (until August 2023) to identify relevant articles, using Medical Subject Headings and keywords. A total of 12 records (eight studies) from four countries were retrieved.

RESULTS

Ten records considered clinical outcomes; eight of these records focused on the effectiveness of videoconferencing as part of routine care. Findings largely demonstrate benefits to glycaemic control, particularly when used during the COVID-19 pandemic; no data were available relating to the impact of videoconferencing use on blood pressure and lipid control in YAT1D. Four records considered satisfaction with use of videoconferencing, with data indicating YAT1D were satisfied with the use of videoconferencing technology.

CONCLUSIONS

There is a need to configure T1D healthcare services to incorporate and offer use of videoconferencing technology, where applicable, appropriate and acceptable for YAT1D, and feasible and workable for service providers. This will require some adjustments from healthcare systems and possible changes to funding mechanisms.

Explanatory variables of objectively measured physical activity, sedentary behaviour and sleep in adults with type 1 diabetes: A systematic review

AIMS

This systematic review aimed to summarize knowledge on explanatory variables of PA, SB and sleep in adults with T1D to support the development of healthy lifestyle interventions.

METHODS

A systematic search of four databases (PubMed, Web of Science, Scopus and Embase) was performed. Only objective measurements of PA, SB and sleep were included and all explanatory variables were classified according to the socio-ecological model (i.e. intrapersonal, interpersonal, environmental and policy level). Risk of bias (ROB) (Joanna Briggs Institute appraisal checklists) and level of evidence (Evidence-Based Guideline Development) were assessed.

RESULTS

Twenty-one studies were included (66.7% low ROB). Most explanatory variables were situated at the intrapersonal level. A favourable body composition was associated with more time spent in total PA and moderate-to-vigorous PA (MVPA). Men with T1D spent more time in MVPA than women and a younger age was associated with increased MVPA. Barriers to PA were indeterminately associated with MVPA and HbA1c showed an indeterminate association with sleep. Explanatory variables of SB and light PA were not studied in at least two independent studies.

CONCLUSION

This review underscores the focus on the individual level to identify explanatory variables of movement behaviours in adults with T1D, despite the necessity for a socio-ecological approach to develop effective interventions. More evidence on psychological, interpersonal and environmental variables is needed as these are modifiable.

MCnebula analysis combined with alpha-glucosidase inhibitory screening reveals potential chemical contributors to efficacy enhancement of natural products after processing

Natural products often show enhanced therapeutic effects after processing, largely due to changes in their chemical profiles. However, identifying the key chemical classes and components responsible for these improvements remains a challenge. In this study, we present a novel workflow for mass spectrometry data analysis, based on our previously developed MCnebula, combined with in vivo and in vitro testing to identify contributors to the anti-diabetic effects of processed natural products. Cornus officinalis (CO), a traditional food and medicinal plant, showed strong α-glucosidase inhibition, particularly its steamed and wine-steamed products, outperforming acarbose in both in vitro and in vivo testing. MCnebula analysis revealed that flavonoids underwent the most significant changes during processing. Further validation of selected flavonoid compounds, such as quercetin and kaempferol, demonstrated their α-glucosidase inhibitory effects to be 207 and 263 times more potent than acarbose, respectively. The combined use of MCnebula analysis and bioactivity validation revealed the key compounds that contribute to the enhanced anti-glucose effects of CO after processing, offering insights into the chemical transformations with bioactive potential as anti-diabetic dietary supplements and agents.

European Survey on Adult People With Type 1 Diabetes and Their Caregivers: Insights into Perceptions of Technology

BACKGROUND

Type 1 diabetes (T1D) is a complex condition requiring constant monitoring and self-management. The landscape of diabetes management is evolving with the development of new technologies. This survey aimed to gain insight into the perceptions and experiences of people with T1D (PWD) and their caregivers on the use of technology in diabetes care, and identify future needs for T1D management.

METHODS

PWD and caregivers (≥18 years) living in five European countries (France, Germany, Italy, Spain, and the United Kingdom) completed an online survey. Data were collected during July and August 2021.

RESULTS

Responders included 458 PWD and 54 caregivers. More than 60% of PWD perceived devices/digital tools for diabetes management as useful and 63% reported that access to monitoring device data made their life easier. Nearly half of participants hoped for new devices and/or digital tools. While approximately one-third of all PWD had used teleconsultation, perceptions and usage varied significantly between countries and by age (both P < .0001), with the lowest use in Germany (20%) and the highest in Spain (48%). The proportions of PWD contributing to diabetes care costs varied by device and were highest for smart insulin pen users at 83% compared with 44% for insulin pen users and 37% for insulin pump users. One-quarter (24%) of PWD and 15% of caregivers felt they lacked knowledge about devices/digital tools for T1D.

CONCLUSIONS

Most PWD and caregivers had positive perceptions and experiences of new technologies/digital solutions for diabetes management, although improved support and structured education for devices/digital tools are still required.

Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

BACKGRUOUND

Automated insulin delivery (AID) systems studies are upsurging, half of which were published in the last 5 years. We aimed to evaluate the efficacy and safety of AID systems in patients with type 1 diabetes mellitus (T1DM).

METHODS

We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov until August 31, 2023. Randomized clinical trials that compared AID systems with other insulin-based treatments in patients with T1DM were considered eligible. Studies characteristics and glycemic metrics was extracted by three researchers independently.

RESULTS

Sixty-five trials (3,623 patients) were included. The percentage of time in range (TIR) was 11.74% (95% confidence interval [CI], 9.37 to 14.12; P<0.001) higher with AID systems compared with control treatments. Patients on AID systems had more pronounced improvement of time below range when diabetes duration was more than 20 years (-1.80% vs. -0.86%, P=0.031) and baseline glycosylated hemoglobin lower than 7.5% (-1.93% vs. -0.87%, P=0.033). Dual-hormone full closed-loop systems revealed a greater improvement in TIR compared with hybrid closed-loop systems (-19.64% vs. -10.87%). Notably, glycemia risk index (GRI) (-3.74; 95% CI, -6.34 to -1.14; P<0.01) was also improved with AID therapy.

CONCLUSION

AID systems showed significant advantages compared to other insulin-based treatments in improving glucose control represented by TIR and GRI in patients with T1DM, with more favorable effect in euglycemia by dual-hormone full closedloop systems as well as less hypoglycemia for patients who are within target for glycemic control and have longer diabetes duration.

Islet Cell Replacement and Regeneration for Type 1 Diabetes: Current Developments and Future Prospects

Type 1 diabetes (T1D) is a chronic autoimmune disorder characterized by the destruction of insulin-producing beta cells in the pancreas, leading to insulin deficiency and chronic hyperglycemia. The main current therapeutic strategies for clinically overt T1D - primarily exogenous insulin administration combined with blood glucose monitoring - fail to fully mimic physiological insulin regulation, often resulting in suboptimal or insufficient glycemic control. Islet cell transplantation has emerged as a promising avenue for functionally replacing endogenous insulin production and achieving long-term glycemic stability. Here, we provide an overview of current islet replacement strategies, ranging from islet transplantation to stem cell-derived islet cell transplantation, and highlight emerging approaches such as immunoengineering. We examine the advancements in immunosuppressive protocols to enhance graft survival, innovative encapsulation, and immunomodulation techniques to protect transplanted islets, and the ongoing challenges in achieving durable and functional islet integration. Additionally, we discuss the latest clinical outcomes, the potential of gene editing technologies, and the emerging strategies for islet cell regeneration. This review aims to highlight the potential of these approaches to transform the management of T1D and improve the quality of life of individuals affected by this condition.

Trends and Racial/Ethnic Differences in Age at Diagnosis of Adult-Onset Type 1 and Type 2 Diabetes in the United States, 2016-2022

INTRODUCTION

Age at diagnosis of diabetes is important for informing public health planning and treatment strategies. This study aimed to estimate trends and racial/ethnic differences in age at diagnosis of adult-onset diabetes by type in the U.S.

METHODS

This serial nationwide cross-sectional study used data from the National Health Interview Survey in 2016-2022. Adults aged ≥18 years with self-reported age at diagnosis of adult-onset type 1 diabetes or type 2 diabetes were included. Trends in mean age at diagnosis of type 1 diabetes and type 2 diabetes and in proportions of people with type 1 diabetes or type 2 diabetes diagnosed at different ages were assessed by linear and logistic regressions. Racial/ethnic differences in mean age at diagnosis of type 1 diabetes and type 2 diabetes were determined.

RESULTS

Included were 1,224 type 1 diabetes cases and 14,221 type 2 diabetes cases. From 2016 to 2022, the mean age at diagnosis of type 2 diabetes increased by 0.18 years annually (95% CI=0.05, 0.30 years, p=0.005), but no significant trend was observed for type 1 diabetes. The proportion of type 2 diabetes cases with diagnosis age ≥60 years increased by 3.17% and with diagnosis age in 18-29 years decreased by 5.62% annually (p≤0.01). On average, Hispanic individuals had type 1 diabetes diagnosed 3.2 years older and minority groups had type 2 diabetes diagnosed 2.0-6.1 years younger than non-Hispanic White individuals (p≤0.02).

CONCLUSIONS

Among U.S. adults, the mean age at diagnosis of adult-onset type 1 diabetes remained stable, and of adult-onset type 2 diabetes increased significantly from 2016 to 2022. Substantial and opposite differences in mean diagnosis age of type 1 diabetes and type 2 diabetes by race/ethnicity were identified.

Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis

Purpose of the Review

Schizophrenia and bipolar disorder are understood to have neuroinflammatory/neuro-immunological basis in their etiopathogenesis. There are few studies synthesizing the association of schizophrenia and bipolar disorder in type 1 diabetes mellitus (T1DM), a common immunological disorder.

Collection and Analysis of Data

We performed meta-analyses of studies assessing the prevalence and risk of schizophrenia and related disorders and bipolar disorder in individuals with T1DM. Fifteen studies consisting of a total sample of 9,768,028 (T1DM: 435,553; non-T1DM controls: 9,332,475) were included. Random-effects meta-analyses using the restricted maximum likelihood method for pooling logit transformed prevalence values and the Mantel-Haenszel test for pooling risk ratios were used. I 2 statistic and the rank correlation test for Funnel plots' asymmetry were used to assess heterogeneity and publication bias, respectively.

Results

Pooled (transformed-back-transformed) prevalence for schizophrenia and related psychotic disorders was 0.37% (95%CI: 0.19-0.73), and for bipolar disorder it was 0.39% (95%CI: 0.05-2.99) (together: 0.38% (95%CI: 0.2-0.71)] in T1DM. The prevalence models showed significant heterogeneity but were statistically significant, had low publication bias, and survived sensitivity analysis. The pooled risk ratio for schizophrenia and related disorders together with bipolar disorder was 1.80 (95%CI: 0.64-5.03), and for schizophrenia and related disorders alone it was 1.19 (95%CI: 0.46-3.11), indicating higher rates of these disorders in T1DM. The pooled risk ratios were not statistically significant and did not survive sensitivity analysis. Trial sequential analysis suggested the need for more studies to confirm increased risk.

Conclusion

With available studies, we could not provide convincing evidence for the hypothesis that the prevalence and risk of schizophrenia and related disorders and bipolar disorder are significantly greater in individuals with T1DM.

Toward a cure for diabetes: iPSC and ESC-derived islet cell transplantation trials

Advancements in regenerative medicine, particularly through the use of induced pluripotent stem cells (iPSCs) and embryonic stem cells (ESCs), are garnering substantial attention as potential solutions to the limited availability of donors, leading to prolonged waiting periods for people with type 1 diabetes who require transplantation of pancreatic islets from deceased donors. The promising outcomes from recent clinical trials suggest that transplantation of iPSC- or ESC-derived islet cells could pave the way for more effective and broadly accessible treatment options. This progress holds potential not only for individuals with type 1 diabetes but may also extend to type 2 diabetes treatment in the future.

The effect of diabetes education given to children with type 1 diabetes mellitus with digital games and video animation on quality of life

PURPOSE

The aim of the study was to examine the effects of diabetes education given to children with Type 1 Diabetes Mellitus with digital game and video animation on quality of life and metabolic control.

DESIGN AND METHODS

The study was an experimental single-blind, randomized controlled design. It was conducted with a total of 55 children with Type 1 Diabetes Mellitus, consisting of a study (n = 27) and a control group (n = 28). Data were collected by the "Introductory Information Form", "Pediatric Quality of Life 3.0 Diabetes Mellitus Module (PedsQL 3.0)" and "Metabolic Control Parameters Monitoring Form". Data were analyzed with Mann Whitney U, Chi square, Friedman and Bonferroni Dunn tests.

RESULTS

The descriptive characteristics of children with type 1 diabetes mellitus were homogeneous. The total mean quality of life scores of children with Type 1 Diabetes Mellitus in the study group were significantly higher than those in the control group (p < 0,05). The average HbA1c scores of the children in the study group decreased (p < 0,05), while the average HbA1c scores of the control group increased (p < 0,05).

CONCLUSIONS

Digital game and video animation based education was found to be effective in improving the quality of life of children with Type 1 Diabetes Mellitus and reducing HbA1c.

PRACTICE IMPLICATIONS

Providing diabetes education to children with Type 1 Diabetes Mellitus with digital games and video animations can facilitate diabetes management.

Aspirin-responsive gene switch regulating therapeutic protein expression

Current small-molecule-regulated synthetic gene switches face clinical limitations such as cytotoxicity, long-term side-effects and metabolic disturbances. Here, we describe an advanced synthetic platform inducible by risk-free input medication (ASPIRIN), which is activated by acetylsalicylic acid (ASA/aspirin), a multifunctional drug with pain-relieving, anti-inflammatory, and cardiovascular benefits. To construct ASPIRIN, we repurpose plant salicylic acid receptors NPR1 and NPR4. Through domain truncations and high-throughput mutant library screening, we enhance their ASA sensitivity. Optimized NPR1 fused with a membrane-tethering myristoylation signal (Myr-NPR1) forms a complex with NPR4, which is fused with a DNA binding domain (VanR) and a transactivation domain (VP16). ASA induces dissociation of the Myr-NPR1/NPR4-VanR-VP16 complex, allowing nuclear translocation of NPR4-VanR-VP16 to activate VanR-operator-controlled gene expression. In male diabetic mice implanted with microencapsulated ASPIRIN-engineered cells, ASA regulates insulin expression, restores normoglycemia, alleviates pain and reduces biomarkers of diabetic neuropathy and inflammation. We envision this system will pave the way for aspirin-based combination gene therapies.

From Microbes to Metabolites: Advances in Gut Microbiome Research in Type 1 Diabetes

Background: Type 1 diabetes (T1D) is a severe chronic T-cell mediated autoimmune disease that attacks the insulin-producing beta cells of the pancreas. The multifactorial nature of T1D involves both genetic and environmental components, with recent research focusing on the gut microbiome as a crucial environmental factor in T1D pathogenesis. The gut microbiome and its metabolites play an important role in modulating immunity and autoimmunity. In recent years, studies have revealed significant alterations in the taxonomic and functional composition of the gut microbiome associated with the development of islet autoimmunity and T1D. These changes include reduced production of short-chain fatty acids, altered bile acid and tryptophan metabolism, and increased intestinal permeability with consequent perturbations of host (auto)immune responses. Methods/Results: In this review, we summarize and discuss recent observational, mechanistic and etiological studies investigating the gut microbiome in T1D and elucidating the intricate role of gut microbes in T1D pathogenesis. Moreover, we highlight the recent advances in intervention studies targeting the microbiota for the prevention or treatment of human T1D. Conclusions: A deeper understanding of the evolution of the gut microbiome before and after T1D onset and of the microbial signals conditioning host immunity may provide us with essential insights for exploiting the microbiome as a prognostic and therapeutic tool.

Exploring the anti-diabetic properties of camel milk: effects on blood glucose, antioxidant defense, and organ histo-morphological features in rabbits

Camel milk (CM) has acquired substantial consideration in contemporary years owing to its potential prospective pharmaceutical benefits besides nutritional properties. As, CM retain inimitable composition and attain sophisticated concentration of bioactive compounds, thus helps in regulation of blood glucose level, and improves insulin sensitivity. Contemporary study intends to explore anti-diabetic inflictions of CM, besides body weight, blood profile, antioxidant defense and organ integrity in diabetic rabbits. To achieve this, a total of 36 rabbits was randomly alienated into six equal groups (N = 6), such as control, control + camel milk, diabetic control, insulin treated, camel milk treated, and CM + insulin. Diabetes was induced by injecting STZ (50-mg/kg). The diabetic rabbits were treated either with CM (100 ml/rabbit/day), or insulin (6 unit/kg/day) and their combination (CM-30 ml + insulin 3-unit/day) for 42 days. Body weight, blood glucose level and hematological indices were measured weekly. Reduced body weight, elevated blood glucose level and altered hematological indices were noticed in diabetes induced rabbits. On the contrary, improved weight gain, glycemic level, anti-oxidant defense and blood chemistry were noticed in groups treated with camel milk individually and insulin; conversely, non-significant changes were seen in CM + insulin treated group. Diabetic control group revealed gross-pathological changes in liver, kidney, intestine and pancreas. CM and insulin augmented organ integrity and stability. Convincingly, these outcomes strongly indicate therapeutic potential of CM that regulated hyperglycemic condition and mitigated the negative impact of diabetes in organ histomorphology.

Bioengineering of a human iPSC-derived vascularized endocrine pancreas for type 1 diabetes

Intrahepatic islet transplantation in patients with type 1 diabetes is limited by donor availability and lack of engraftment. Alternative β cell sources and transplantation sites are needed. We demonstrate the feasibility to repurpose a decellularized lung as an endocrine pancreas for β cell replacement. We bioengineer an induced pluripotent stem cell (iPSC)-based version, fabricating a human iPSC-based vascularized endocrine pancreas (iVEP) using iPSC-derived β cells (iPSC-derived islets [SC-islets]) and endothelial cells (iECs). SC-islets and iECs are aggregated into vascularized iβ spheroids (ViβeSs), and over 7 days of culture, spheroids integrate into the bioengineered vasculature, generating a functional, perfusable human endocrine organ. In vitro, the vascularized extracellular matrix (ECM) sustained SC-islet engraftment and survival with a significantly preserved β cell mass and a physiologic insulin release. In vivo, iVEP restores normoglycemia in diabetic NSG mice. We report a human iVEP providing a controlled in vitro insulin-secreting phenotype and in vivo function.

Unveiling the Therapeutic Potential of the Second-Generation Incretin Analogs Semaglutide and Tirzepatide in Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic beta cells, resulting in the lifelong need for exogenous insulin. Over the last few years, overweight and obesity have recently emerged as growing health issues also afflicting patients with T1D. In this context, the term "double diabetes" has been coined to indicate patients with T1D who have a family history of type 2 diabetes mellitus (T2D) and/or patients with T1D who are affected by insulin resistance and/or overweight/obesity and/or metabolic syndrome. At the same time, the use of second-generation incretin analogs semaglutide and tirzepatide has substantially increased on a global scale over the last few years, given the remarkable clinical benefits of these drugs (in terms of glucose control and weight loss) in patients with T2D and/or overweight/obesity. Although the glucagon-like peptide-1 (GLP-1) receptor agonists and the novel dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 receptor agonist tirzepatide are currently not approved for the treatment of T1D, a growing body of evidence over the last few years has shown that these medications may serve as valid add-on treatments to insulin with substantial efficacy in improving glucose control, promoting weight loss, preserving residual beta-cell function and providing other beneficial metabolic effects in patients with T1D, double diabetes and latent autoimmune diabetes in adults (LADA). This manuscript aims to comprehensively review the currently available literature (mostly consisting of real-world studies) regarding the safety and therapeutic use (for different purposes) of semaglutide and tirzepatide in patients with T1D (at different stages of the disease), double diabetes and LADA.

Beyond Tuberculosis: The Surprising Immunological Benefits of the Bacillus Calmette-Guérin (BCG) Vaccine in Infectious, Auto-Immune, and Inflammatory Diseases

The Bacillus Calmette-Guérin (BCG) vaccine, best known for its role in preventing tuberculosis, has recently garnered attention for its broader immunomodulatory effects. By inducing trained immunity, BCG reprograms innate immune cells, enhancing their responses to various pathogens. This process, driven by epigenetic and metabolic reprogramming, suggests that BCG may have therapeutic potential far beyond tuberculosis. Emerging evidence points to its potential benefits in conditions such as autoimmune diseases, cancer, and viral infections. Furthermore, by modulating immune activity, BCG has been proposed to reduce chronic inflammation and promote immune tolerance. This review delves into the multifaceted role of BCG, highlighting its potential as a versatile therapeutic tool for managing a wide range of diseases.

Correlation of cumulative fasting blood glucose exposure with gastrointestinal cancers: A prospective cohort study

At present, there is a lack of research on the correlation between cumFPG and digestive malignancies, and previous cohort studies have not considered the competitive risk between death and digestive malignancies, which may overestimate the impact of related risk factors. To explore the correlation between cumFPG and malignant tumors of the digestive system. In this study, 53,747 participants who had undergone 3 consecutive physical examinations since 2006 were collected. Finally, a total of 53,747 participants were included in this study. According to the grouping method of previous studies, cumFPG was divided into 4 groups according to the quartile. Cox regression model and competitive risk model were used to assess the risk of new digestive system malignancy. In sensitivity analyses, participants with cancer within 5 years of follow-up were excluded to eliminate the possibility of reverse causation. Subjects taking hypoglycemic drugs were excluded to eliminate the effect of the drug on blood glucose. Restricted cubic splineregresion (RCS) was then used to calculate the relationship between cumFPG and GI cancers. The mean age of participants was 49.02 ± 11.78 years. During a mean follow-up of 10.58 years, 817 new Gastrointestinal cases were identified, and the Cox proportional hazards model suggested that the risk of incidence in the Q2 to Q4 group increased sequentially compared with the lowest Q1 group, even after excluding the diagnosis of digestive malignancy within 5 years, the participants taking hypoglycemic drugs, and the death competition risk model analysis. In site-specific analysis, we observed that this risk was more pronounced in colorectal cancer, liver cancer, and pancreatic cancer, while gastric cancer, small bowel cancer, and bile duct cancer all had a similar trend to the main model but were not statistically significant, while esophageal cancer was U-shaped but not statistically significant. RCS results showed that cumFPG was associated with a similar risk of digestive system tumors, showing an inverted "√" type relationship. High levels of cumFPG are an independent factor in malignancy of the digestive system. cumFPG can provide a new idea for the prevention of Gastrointestinal cancers.

Short-Term Diabetic Retinopathy Status in People with Type 1 Diabetes Commencing Automated Insulin Delivery

Objective: Rapid improvements in glucose control may lead to early worsening of diabetic retinopathy (EWDR). There is a need to demonstrate safety in people commencing automated insulin delivery (AID) due to the known efficacy in rapid glycemic improvement. We aimed to investigate short-term DR outcomes in people (aged ≥13 years) with type 1 diabetes after initiation of AID (use ≥6 months). Research Design and Methods: Retrospective four center observational study with participants drawn from hospital databases (Dunedin and Christchurch, New Zealand) and also from two research studies based out of Auckland, New Zealand, and Perth, Australia. Demographic and clinical characteristics and DR grading data before and after AID initiation were collected, and statistical analysis was performed. Results: DR grading data from 165 people using AID (three different AID systems) were available, and mean improvement in HbA1c for the total sample was 1.0 ± 1.3 percentage points. Improvements in grading were seen in 32/165 (19%), 99/165 (60%) were stable, and 34/165 (21%) worsened in their R- and/or M-grade. Age at AID initiation ≥18 years was the only significant risk factor for any worsening of DR (P = 0.028). Proliferative change and need for photocoagulation were uncommon but did occur in 3% (5/165); all noted to have prior DR, diabetes duration >10 years, and with at least another diabetes complication or prior DR treatment. Conclusions: In this study, stable or improved DR grades were evident in most who had recently commenced AID. Age at AID initiation <18 years appears protective.

Interaction of B0AT1 Deficiency and Diet on Metabolic Function and Diabetes Incidence in Male Nonobese Diabetic Mice

CONTEXT

The obesity epidemic parallels an increasing type 1 diabetes incidence, such that westernized diets, containing high fat, sugar, and/or protein, through inducing nutrient-induced islet β-cell stress, have been proposed as contributing factors. The broad-spectrum neutral amino acid transporter (B0AT1), encoded by Slc6a19, is the major neutral amino acids transporter in intestine and kidney. B0AT1 deficiency in C567Bl/6J mice causes aminoaciduria, lowers insulinemia, and improves glucose tolerance.

OBJECTIVE

We investigated the effects of standard rodent chow (chow), high-fat high-sucrose (HFHS), and high-fat high-protein (HFHP) diets, in addition to B0AT1 deficiency, on the diabetes incidence of male nonobese diabetic (NOD/ShiLtJArc (NOD)) mice.

METHODS

Male NOD.Slc6a19+/+ and NOD.Slc6a19-/- mice were fed chow, HFHS and HFHP diets from 6 to 24 weeks of age. A separate cohort of male NOD mice were fed the three diets from 6-30 weeks of age. Body weight and fed-state blood glucose and plasma insulin were monitored, and urinary amino-acid profiles, intraperitoneal glucose tolerance, diabetes incidence, pancreatic islet number, insulitis scores and beta-cell mass were measured.

RESULTS

The incidence of diabetes and severe glucose intolerance was 3.8% in HFHS-fed, 25.0% in HFHP-fed, and 14.7% in chow-fed mice, with higher pancreatic islet number and lower insulitis scores in HFHS-fed mice. B0AT1 deficiency had no effect on diabetes incidence, but curtailed HFHS-induced excessive weight gain, adipose tissue expansion, and hyperinsulinemia. In HFHP-fed mice, B0AT1 deficiency significantly increased pancreatic β-cell clusters and small islets. Male NOD mice that did not develop autoimmune diabetes were resistant to diet-induced hyperglycemia.

CONCLUSION

Dietary composition does, but B0AT1 deficiency does not, affect autoimmune diabetes incidence in male NOD mice. B0AT1 deficiency, however, reduces diet-induced metabolic dysfunction and in HFHP-fed mice increases pancreatic β-cell clusters and small islets.

Population characteristics, prescription patterns and glycemic control of users of flash glucose monitoring systems in Brazil: a real-world evidence study

BACKGROUND

To date, there is a lack of information on the use of flash glucose monitoring system (fCGM) in low-middle income countries, such as Brazil, as well as on digital health platforms most used to calculate the bolus insulin dose. In this study, we aimed to describe the population characteristics, prescription patterns and glycemic control of fCGM users compared to blood glucose monitoring (BGM) system in those who use Glic™, a digital health platform in Brazil, and to assess factors associated with better glycemic control in this population.

METHODS

This study is a cross-sectional retrospective study using anonymized aggregated data manually inputted by Glic™ users who self-reported a diagnosis of type 1 diabetes (T1DM), type 2 diabetes (T2DM), gestational diabetes (GDM) and latent autoimmune diabetes in adults (LADA).

RESULTS

Of the 12,727 individuals included in this study, 11,007 (86.5%) reported their glucose monitoring method to be BGM, while 1720 (13.5%) reported using fCGM. Most individuals (70.5%) had T1DM. Compared to BGM, fCGM users were significantly younger, had a higher proportion of males, resided more frequently in the Southeast region of Brazil, had a lower BMI, a longer time since diagnosis, and used Glic™ platform more frequently. fCGM users were prescribed significantly more ultra-long and ultra-rapid acting insulins as their basal and bolus insulin, respectively, and less oral anti-diabetics drugs compared to BGM users. Considering only the T1DM and LADA individuals and their manual glucose inputs, fCGM users had non-significant lower glucose levels than BGM. Use of Glic™ platform and a higher percentage of basal insulin dose were associated with a better glycemic control.

CONCLUSION

This is the first and largest real-world evidence study that describe and compare fCGM and BGM in users of a digital health patient support platform in Brazil. fCGM users were significantly different from those who perform BGM, in terms of population characteristics and treatment patterns. Glycemic control was better in fCGM users, although not statistically significant due to a restricted sample size. Importantly, a higher frequency of Glic™ use was associated with a higher glucose time in range.

Exploring proteomic immunoprofiles: common neurological and immunological pathways in multiple sclerosis and type 1 diabetes mellitus

BACKGROUND

Interest in the study of type 1 diabetes mellitus (T1DM) and multiple sclerosis (MS) has increased because of their significant negative impact on the patient quality of life and the profound implications for the health care system. Although the clinical symptoms of T1DM differ from those of MS, such as pancreatic β-cell failure in T1DM and demyelination in the central nervous system (CNS) in MS, both pathologies are considered as autoimmune-related diseases with shared pathogenic pathways, which include autophagy, inflammation and degeneration, among others. Considering the challenges in obtaining pancreatic β-cells and CNS tissue from patients with T1DM and MS, respectively, it is fundamental to explore alternative methods for evaluating disease status. Proteomic analysis of peripheral blood mononuclear cells (PBMCs) is an ideal approach for identifying novel and potential biomarkers for both autoimmune diseases.

METHODS

We conducted a proteomic analysis of PBMCs from patients with T1DM and relapsing remitting Multiple Sclerosis (herein forth MS) patients (n = 9 per condition), using a label-free quantitative proteomics approach. The patients were diagnosed following the American Diabetes Association (ADA) criteria for T1DM and McDonald criteria for MS respectively, and were aged over 18 years and more than 2 years from the onset respectively.

RESULTS

A total of 2476 proteins were differentially expressed in PBMCs from patients with T1DM and MS patients compared with those form healthy controls (H). Predictive analysis highlighted 15 common proteins, up- or downregulated in PBMCs from patients with T1DM and MS patients vs. healthy controls, involved in the immune system activity (BTF3, TTR, CD59, CSTB), diseases of the neuronal system (TTR), signal transduction (STMN1, LAMTOR5), metabolism of nucleotides (RPS21), proteins (TTR, ENAM, CD59, RPS21, SRP9) and RNA (SRSF10, RPS21). In addition, this study revealed both shared and distinct molecular patterns between the two conditions.

CONCLUSIONS

Compared with H, patients with T1DM and MS presented a specific expression pattern of common proteins has been identified. This pattern underscores the shared mechanisms involved in their immune responses and neurological complications, alongside dysregulation of the autophagy pathway. Notably, CSTB has emerged as a differential biomarker, distinguishing between these two autoimmune diseases.

Effect of Tirzepatide on Body Weight and Diabetes Control in Adults With Type 1 Diabetes and Overweight or Obesity

OBJECTIVE

To determine the effect of tirzepatide on weight, diabetes control, and insulin requirements, and its safety profile in adults with type 1 diabetes (T1D) and overweight or obesity.

PATIENTS AND METHODS

This is a retrospective study of adults with T1D using tirzepatide for overweight/obesity treatment between June 1, 2022, and October 31, 2023, at Mayo Clinic. Fifty-one patients fulfilled inclusion and exclusion criteria (adults with established T1D diagnosis and a body mass index ≥27 kg/m2 using tirzepatide for 3 months or longer and without a history of bariatric surgery or active malignancy). Data were collected from the electronic medical record and reported as median (Q1-Q3).

RESULTS

Most individuals were female (30, 58.8%), White (49, 96.1%), and with obesity class III (21, 41.2%). During a median follow-up time of 8.0 (Q1-Q3: 4.0-10.0) months, the total body weight loss was 8.5% (Q1-Q3: 5.3%-13.8%) (P<.01). At 12 months, total body weight loss was 12.2% (Q1-Q3: 7.3%-19.8%) (n=26). By the last follow-up, hemoglobin A1c decreased by 0.9% (Q1-Q3: 0.3%-1.1%) (P<.0001) and daily insulin requirements by 31.6% (Q1-Q3: -48.0% to -10.9% (P<.01). Basal and bolus insulin doses decreased proportionally, with a more precipitous decline during the first 6 months of tirzepatide therapy. The use of tirzepatide was associated with an improvement of cardiometabolic parameters. There was no increased incidence of hypoglycemia. The most common side effect was nausea (7, 13.7%).

CONCLUSION

Tirzepatide for the treatment of overweight and obesity in adults with T1D leads to substantial weight loss, improved diabetes control, and decreased insulin requirements, without worsening hypoglycemia. Future studies are needed to ascertain the long-term effect of tirzepatide in this population, ideally focusing on cardiovascular outcomes.

Beta cell extracellular vesicle PD-L1 as a novel regulator of CD8+ T cell activity and biomarker during the evolution of type 1 diabetes

AIMS/HYPOTHESIS

Surviving beta cells in type 1 diabetes respond to inflammation by upregulating programmed death-ligand 1 (PD-L1) to engage immune cell programmed death protein 1 (PD-1) and limit destruction by self-reactive immune cells. Extracellular vesicles (EVs) and their cargo can serve as biomarkers of beta cell health and contribute to islet intercellular communication. We hypothesised that the inflammatory milieu of type 1 diabetes increases PD-L1 in beta cell EV cargo and that EV PD-L1 may protect beta cells against immune-mediated cell death.

METHODS

Beta cell lines and human islets were treated with proinflammatory cytokines to model the proinflammatory type 1 diabetes microenvironment. EVs were isolated using ultracentrifugation or size exclusion chromatography and analysed via immunoblot, flow cytometry and ELISA. EV PD-L1 binding to PD-1 was assessed using a competitive binding assay and in vitro functional assays testing the ability of EV PD-L1 to inhibit NOD CD8+ T cells. Plasma EV and soluble PD-L1 were assayed in the plasma of islet autoantibody-positive (Ab+) individuals or individuals with recent-onset type 1 diabetes and compared with levels in non-diabetic control individuals.

RESULTS

PD-L1 protein co-localised with tetraspanin-associated proteins intracellularly and was detected on the surface of beta cell EVs. Treatment with IFN-α or IFN-γ for 24 h induced a twofold increase in EV PD-L1 cargo without a corresponding increase in the number of EVs. IFN exposure predominantly increased PD-L1 expression on the surface of beta cell EVs and beta cell EV PD-L1 showed a dose-dependent capacity to bind PD-1. Functional experiments demonstrated specific effects of beta cell EV PD-L1 to suppress proliferation and cytotoxicity of murine CD8+ T cells. Plasma EV PD-L1 levels were increased in Ab+individuals, particularly in those positive for a single autoantibody. Additionally, in Ab+ individuals or those who had type 1 diabetes, but not in control individuals, plasma EV PD-L1 positively correlated with circulating C-peptide, suggesting that higher EV PD-L1 could be protective for residual beta cell function.

CONCLUSIONS/INTERPRETATION

IFN exposure increases PD-L1 on the beta cell EV surface. Beta cell EV PD-L1 binds PD1 and inhibits CD8+ T cell proliferation and cytotoxicity. Circulating EV PD-L1 is higher in Ab+ individuals than in control individuals. Circulating EV PD-L1 levels correlate with residual C-peptide at different stages in type 1 diabetes progression. These findings suggest that EV PD-L1 could contribute to heterogeneity in type 1 diabetes progression and residual beta cell function and raise the possibility that EV PD-L1 could be exploited as a means to inhibit immune-mediated beta cell death.

Low-carbohydrate diet proved effective and safe for youths with type 1 diabetes: A randomised trial

AIM

Low-carbohydrate (LC) diets have gained popularity. We compared glycaemic and metabolic parameters following an LC versus a Mediterranean (MED) diet in adolescents and youths with type 1 diabetes.

METHODS

In a six-month, open-label, randomised trial, 40 individuals were assigned to either diet. Glycaemic outcomes, based on continuous glucose monitoring, included per cent time of blood glucose in the range [3.9-10.0 mmol/L (70-180 mg/dL)] and haemoglobin A1c (HbA1c).

RESULTS

Twenty-eight (70%) were females. The median age was 18 years. After 6 months, the median time in range increased from 47% to 58% in the LC and from 52% to 64% in the MED diet group (p = 0.98). The delta values for the time in range were 16% and 7% for the respective groups (p = 0.09). The percentage of time >13.9 mmol/L (>250 mg/dL) improved more in the LC diet than in the MED diet group: -10% vs. -2% (p = 0.005). The percentage of time <3.0 mmol/L (<54 mg/dL) was comparable. The delta HbA1c improved in both groups: -0.7% vs. -0.1% (p = 0.02). Changes in BMI Z-score and lipid levels were similar.

CONCLUSION

Both diets improved glycaemic outcomes in adolescents and youths with type 1 diabetes, without increasing hypoglycaemia or cardiovascular risk factors, indicating comparable safety and efficacy.

Beneficial effects of the remifentanil/thiopental combination on cardiac function and redox status in diabetic rats

This study aimed to examine the effect of thiopental monotherapy as well as its combination with different agents used in anesthesia induction, on cardiac function and redox state of rats with type 1 diabetes mellitus (T1DM). A total of 40 Wistar albino male rats were used in this study and randomly divided into five groups: thiopental (TIO), fentanyl + thiopental (FEN + TIO), remifentanil + thiopental (REM + TIO), midazolam + thiopental (MID + TIO), and dexmedetomidine + thiopental (DEX + TIO). Animals were anesthetized by intraperitoneal injection of thiopental 85 mg/kg, fentanyl 0.005 mg/kg, remifentanil 0.04 mg/kg, midazolam 2.5 mg/kg, and dexmedetomidine 0.05 mg/kg of body weight. Four weeks after T1DM induction, all animals were subjected to a short narcosis of tested anesthetic, sacrificed by cervical dislocation and the hearts were retrogradely perfused according to Langendorff technique. Our research demonstrated that most combined anesthetics negatively influenced cardiodynamic parameters and redox state in diabetic rats. However, significantly improved cardiac contractility associated with enhanced antioxidative capacity was achieved in the combination of TIO with REM, which distinguishes this anesthetic combination as the therapy with the most pronounced positive effect on cardiac function in state of T1DM.

The impact of gut microbiome on immune and metabolic homeostasis in type 1 diabetes: Clinical insights for prevention and treatment strategies

Type 1 diabetes (T1D) is a complex disease triggered by a combination of genetic and environmental factors, where abnormal autoimmune responses lead to progressive damage of the pancreatic β cells and severe glucose metabolism disorder. Recent studies have increasingly highlighted the close link between gut microbiota dysbiosis and the development of T1D. This review delves into existing population studies to explore the intricate interactions between the gut microbiota and the immune and metabolic homeostasis in T1D. It summarizes how changes in the structure and function of the gut microbiota are closely associated with the onset and progression of T1D across its natural course and clinical stages. More importantly, based on evidence accumulated from clinical observations and trials, we pioneer the discussion on gut microbiota-based T1D prevention and treatment strategies, this not only enriches our understanding of the complex pathological mechanisms of T1D but also provides potential directions for developing novel prevention and treatment strategies.

Reduction of Chemokine CXCL9 Expression by Omega-3 Fatty Acids via ADP-Ribosylhydrolase ARH3 in MIN6 Insulin-Producing Cells

Type 1 diabetes (T1D) results from the autoimmune destruction of the insulin-producing β cells of the pancreas. Omega-3 fatty acids protect β cells and reduce the incidence of T1D, but the mechanism is poorly understood. We have shown that omega-3 fatty acids reduce pro-inflammatory cytokine-mediated β-cell apoptosis by upregulating the expression of the ADP-ribosylhydrolase ARH3. Here, we further investigate the β-cell protection mechanism of ARH3 by performing siRNA analysis of its gene Adprhl2 in MIN6 insulin-producing cells, subsequent treatment with a cocktail of the pro-inflammatory cytokines IL-1β + IFN-γ + TNF-α, followed by proteomics analysis. ARH3 regulated proteins from several pathways related to the nucleus (splicing, RNA surveillance, and nucleocytoplasmic transport), mitochondria (metabolic pathways), and endoplasmic reticulum (protein folding). ARH3 also regulated the levels of proteins related to antigen processing and presentation, and the chemokine-signaling pathway. We further studied the role of ARH3 in regulating the chemokine CXCL9. We found that ARH3 reduces the cytokine-induced expression of CXCL9, which is dependent on omega-3 fatty acids. In conclusion, we demonstrate that omega-3 fatty acids regulate CXCL9 expression via ARH3, which may have a role in protecting β cells from immune attack thereby preventing T1D development. Significance of the Study: Omega-3 fatty acids have a variety of health benefits. In type 1 diabetes, omega-3 fatty acids reduce the islet autoimmune response and the disease development. Here, we studied the pathways regulated by the adenosine diphosphate (ADP)-ribosylhydrolase ARH3, a protein whose expression is regulated by omega-3 fatty acids. We showed that ARH3 reduces the expression of chemokines in response to omega-3 fatty acids. This represents an anti-inflammatory mechanism of omega-3 fatty acids that might be involved with protection against type 1 diabetes development.

In Vivo Mouse Abdominal Oxygen Imaging And Assessment of Subcutaneously Implanted Beta Cell Replacement Devices

PURPOSE

Type 1 diabetes (T1D) is an autoimmune disease that leads to the loss of insulin-producing pancreatic beta cells. Beta cell replacement devices or bioartificial pancreas (BAP) have shown promise in curing T1D and providing long-term insulin independence without the need for immunosuppressants. Hypoxia in BAP devices damages cells and imposes limitations on device dimensions. Noninvasive in vivo oxygen imaging assessment of implanted BAP devices will provide the necessary feedback and improve the chances of success. Pulse-mode electron paramagnetic resonance (EPR) oxygen imaging (EPROI) using injectable trityl OX071 as the oxygen-sensitive agent is an excellent technique for obtaining partial oxygen pressure (pO2) maps in vitro and in vivo. In this study, our goal was to optimize in vivo mouse abdominal EPROI and demonstrate proof-of-concept pO2 imaging of subcutaneously implanted BAP devices.

METHODS

All EPROI experiments were performed using a 25 mT EPROI instrument, JIVA-25®. For in vivo EPROI experiments, trityl OX071, a whole-body mouse resonator (∅32 mm × 35 mm), C57BL6 mice, and the inversion recovery electron spin echo (IRESE) pulse sequence were utilized. We investigated the signal amplitude and pO2 in mouse abdomen region for intravenous (i.v.) and intraperitoneal (i.p.) injection methods with either only a single bolus (B) or bolus plus infusion (BI) for 72.2 mM OX071 and the effect of OX071 concentrations from 18 to 72.2 mM for the i.p.-B injection method. We also investigated the impact of animal respiratory rate on mouse abdominal pO2. Finally, we performed proof-of-concept pO2 imaging of two subcutaneously implanted BAP devices, OxySite and TheraCyte. At the end of the four-week study, the TheraCyte devices were extracted and analyzed for fibrosis, vascular differentiation, and immune cell infiltration.

RESULTS

We established that mouse abdominal pO2 remains stable irrespective of trityl injection methods, concentrations, imaging time, or animal breathing rate. We demonstrate that the i.p.-B and i.p.-BI methods are suitable for EPROI, and i.p.-B method provides higher signal amplitude compared to i.v.-BI and up to 75 min of imaging. An injection with a reduced trityl concentration and higher volume provides higher signal amplitude for i.p.-B method at the beginning. We also highlight the advantage of milder anesthesia for consistent, reliable mouse pO2 imaging. Finally, we demonstrate that EPROI could provide longitudinal noninvasive oxygen assessment of subcutaneously implanted BAP devices in vivo.

CONCLUSIONS

In vivo EPROI is a reliable technique for mouse abdominal oxygen imaging and longitudinal assessment of subcutaneously implanted BAP devices noninvasively. This work reports abdominal oxygen imaging in the mouse model and demonstrates its application for the assessment of BAP devices. Even though the application focus of this work was on cell therapy, the techniques developed will have a much broader use in the biomedical field.

Therapeutic Effects of Lavender Oil on Streptozotocin-Induced Diabetes Mellitus and Experimental Thrombosis

Diabetes mellitus is a metabolic disorder associated with oxidative stress, inflammation, and coagulation disturbances, which contribute to microvascular and macrovascular complications. We evaluated the therapeutic effects of lavender oil (Lavandula angustifolia) in a streptozotocin (STZ)-induced rat model of type 1 diabetes mellitus (T1DM) with experimentally induced thrombosis. Sixty male Wistar rats were divided into control, thrombosis, diabetes, thrombosis-diabetes, and lavender oil pretreatment groups (100 and 200 mg/kg body weight [bw]). Lavender oil exhibited dose-dependent benefits, with the 200 mg/kg bw dose leading to significant reductions in proinflammatory cytokines (e.g., tumor necrosis factor α (TNF-α); regulated upon activation, normal T cell expressed and secreted (RANTES); and monocyte chemoattractant protein-1 (MCP-1)) and oxidative stress, along with improved glycemic control, the partial restoration of C-peptide levels, and the attenuation of matrix metalloproteinase 2 and 9 (MMP-2 and MMP-9) activity (p < 0.0001). Histopathological and coagulation analyses confirmed its organ-protective and antithrombotic effects, including reduced tissue damage, vascular inflammation, and thrombus formation, and prolonged bleeding and clotting times. Our findings suggest that lavender oil exhibits dose-dependent antioxidant, anti-inflammatory, hypoglycemic, and organ-protective effects, indicating its potential as a complementary therapy for managing inflammation in T1DM with or without thrombosis.

Human versus Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings (HumAn-1): protocol for a randomised controlled trial

INTRODUCTION

Long-acting insulin analogues are the standard of care for people with type 1 diabetes (T1D) in high-income countries but remain largely inaccessible and understudied in low-resource settings. In settings where glycaemic control is typically poor and food insecurity is common, long-acting insulin analogues may offer tangible clinical benefits for people with T1D. To determine whether insulin glargine, a long-acting insulin analogue, reduces the risk of serious hypoglycaemia and/or improves glycaemic time-in-range (TIR) versus human insulin regimens in this population, we are conducting the Human vs Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings randomised controlled trial.

METHODS AND ANALYSIS

This is a 1:1 randomised, parallel-group clinical trial comparing biosimilar insulin glargine with human insulin (Neutral Protamine Hagedorn (NPH) or premixed 70/30 insulin) in 400 youth with type 1 diabetes (T1D) recruiting in Dhaka, Bangladesh (n=250) and Mwanza, Tanzania (n=150). Blinded continuous glucose monitors will be used to assess glycaemic control in both study arms over 14-day periods at baseline and at 3, 6 and 12 months after randomisation. The co-primary outcomes are the per cent time in serious hypoglycaemia (<54 mg/dL) and TIR (70-180 mg/dL) at 6 months of follow-up. Secondary outcomes include TIR at 12 months and time-in-hypoglycaemia, time-above-range, nocturnal hypoglycaemic events and glycaemic control (ie, haemoglobin A1C (HbA1c)) at 6- and 12-months of follow-up. Treatment satisfaction and quality of life are assessed at baseline, 6- and 12 month follow-up. Additionally, the study is conducting qualitative interviews, quantitative assessments of treatment satisfaction and quality of life, as well as assessing the cost-effectiveness of analogue insulin use in low-resource settings.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board at the University of Pittsburgh (STUDY21110122), the National Health Research Ethics Committee at the National Institute for Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4265) and the Ethical Review Committee (ERC) of Diabetic Association of Bangladesh (BADAS-ERC/EC/22/405). Research findings will be shared by the local partner organisations and institutions with relevant stakeholders including youth living with diabetes, policy makers, healthcare workers and the general public. Findings will also be shared at local, regional and international scientific meetings.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT05614089.

Geographic information system mapping and predictors of glycemic control in children and youth with type 1 diabetes: a study from Western India

OBJECTIVES

Geographic Information System (GIS) mapping, is a novel way to provide insights into spatial distribution of type 1 diabetes (T1D) and associations between T1D outcomes and potential predictors. We aimed to explore GIS in children with T1D, and identify predictors of poor glycemic control.

METHODS

Design: Cross-sectional; Participants: 402 children and youth (187 boys) with T1D. Place of residence (coordinates) of participants were geocoded in GIS. They were divided into two groups living in urban or peri-urban areas using ArcGIS Pro. The characteristics of urban/peri-urban living were linked to sociodemographic and biochemical data and spatial autocorrelation analysis was performed. Association between glycemic control and distance to our unit was studied.

RESULTS

Mean age was 13.2 ± 4.7 years; 196 children were living in urban areas, 206 in peri-urban areas. There was significant difference in HbA1c between groups (Urban 9.9 (9.7, 10.2) %, Peri-urban 10.5 (10.1, 10.8) %) (p=0.004); mean difference 0.5 (0.1, 1.0) with poorer glycemic control and higher prevalence of vitamin D sufficiency in peri-urban and higher prevalence of hypothyroidism in urban areas. There was significant correlation between glycemic control (HbA1c) and distance to our unit r=0.108 (0.023, 0.218) (p=0.031). Individuals with an HbA1c ≥9.5 were residing farther away (58.9 (49.4, 68.5) km) as compared to those with HbA1c <9.5 (44.5 (35.1, 53.9) km) (p<0.05).

CONCLUSIONS

Children with T1D when grouped using GIS had differences in glycemic control and comorbidities; peri-urban participants and those residing further away from our unit had poorer glycemic control. Future efforts may be aimed at identifying centers and channelizing resources towards children showing poor glycemic control, thus optimizing disease management.

Diabetes Mellitus Impairs Blood-Brain Barrier Integrality and Microglial Reactivity

Diabetes mellitus (DM), a chronic metabolic disorder that adversely affects the blood-brain barrier (BBB) and microglial function in the central nervous system (CNS), contributing to neuronal damage and neurodegenerative diseases. However, the underlying molecular mechanisms linking diabetes to BBB dysfunction and microglial dysregulation remain poorly understood. Here, we assessed the impacts of diabetes on BBB and microglial reactivity and investigated its mechanisms. We found diabetes severely disrupted the BBB integrity and microglial response to vascular injury. We also revealed a potential relationship between BBB disruption and impaired microglial function, whereby increasing BBB permeability led to a downregulation of microglial P2RY12 expression, thereby impairing microglial protection against cerebrovascular injury. Understanding these mechanisms may contribute to the developing of therapeutic strategies for diabetes-related neurological complications.

The impact of pancreas transplantation on diabetic complications: A systematic review

BACKGROUND

Pancreas Transplantation (PT) provides optimal treatment for patients with severe complicated Type 1 Diabetes Mellitus (T1DM). Restoration of beta-cell mass allows return to euglycaemia and insulin independence. We aimed to examine its impact on the secondary complications associated with severe T1DM including diabetic eye disease, neuropathy and cardiovascular disease.

METHODS

A database search using MedLINE to identify publications to April 2023 was conducted. Searches were performed using MeSH terms 'Pancreas Transplantation' AND 'Diabetes Mellitus, Type 1' 'Diabetic Retinopathy' OR 'Heart Disease' OR 'Cardiovascular Diseases' OR 'Peripheral Vascular Disease' OR "Amputation' OR 'Neuropathy."

RESULTS

All articles were retrospective with 51.1 % (n = 23) case control studies and 48.9 % (n = 22) cohort studies. 82.2 % (n = 37) examined simultaneous pancreas and kidney (SPK) transplantation and 17.8 % (n = 8) analysed pancreas transplant alone (PTA). Heterogenous outcomes metrics were employed. 15 studies examined diabetic retinopathy (DR) with 53.3 % (n = 8) demonstrated improvements after PT, while the remainder (n = 7) exhibited stabilisation. 16 studies assessed neuropathy and 87.5 % (n = 14) demonstrated beneficial effects of PT on nerve conduction studies, vibration perception threshold or corneal confocal microscopy. There was a positive effect on cardiovascular disease by reduction in the incidence of cardiac events, improvement in metabolic profile and increased left ventricular ejection fraction. 14 studies examined cardiovascular disease (71.4 % (n = 10) improvement; 14.2 % (n = 2) stabilisation; 14.2 % (n = 2) progression).

CONCLUSION

SPK and PTA have beneficial effects in ameliorating or stabilising diabetes complications. Future work should seek to reduce heterogeneity of outcome metrics assessing T1DM complication profile to facilitate robust comparison of beta-cell replacement interventions.

Assessing the Colorectal Cancer Landscape: A Comprehensive Exploration of Future Trends in 216 Countries and Territories from 2021 to 2040

BACKGROUND

Colorectal cancer (CRC) has become a significant global concern, presenting formidable challenges to healthcare systems and leading to substantial healthcare expenses. This study examines the projected prevalence and trends of CRC worldwide, encompassing 21 regions and 195 nations.

METHODS

We employed an illness-death model (IDM) in order to forecast the anticipated prevalence of CRC by the year 2040. To accomplish this, we utilized data retrieved from the Global Health Data Exchange (GHDx) query tool spanning from 1990 to 2021. The primary objective of this study is to furnish sex-specific estimations encompassing various geographical regions.

RESULTS

By 2040, the global age-standardized prevalence rate (ASPR) of CRC among the total population is projected to rise, reaching 145.82 per 100,000, which reflects an increase of 8.15%. East Asia is forecasted to have the highest ASPR at 330.17 per 100,000, representing a substantial rise of 94.81%. Notably, the most rapid percentage increase is projected in Andean Latin America, with an anticipated rise of 106.2%. In contrast, many countries, particularly in developed nations, are expected to see a decline in ASPR during this period. The United Arab Emirates is projected to experience the most significant decrease in ASPR, at -86.51%, while Mauritius is anticipated to have the largest increase in CRC prevalence rate, at 226.26%. Globally and regionally, the ASPR among males is expected to remain higher than that among females over the next 21 years.

CONCLUSIONS

The global prevalence of CRC is increasing, particularly in developing countries, while developed countries are anticipated to observe a declining trend. This highlights the significance of appropriately allocating resources and implementing effective preventive measures, especially in developing nations.

Weight stigma in pediatric type 1 diabetes: An associated risk for disordered eating?

Adolescents with type 1 diabetes (T1D) have elevated eating disorder risk. No studies have examined weight stigma as a potential factor associated with disordered eating. This study investigated cross-sectional associations among weight-based victimization, weight bias internalization, and disordered eating in adolescents with T1D. Adolescents (12-17 years; N = 166) self-reported experiences of weight-based victimization from peers, family members, and healthcare professionals. The Weight Bias Internalization Scale (WBIS) and Diabetes Eating Problems Survey (DEPS-R) assessed internalized weight bias and disordered eating, respectively. In a series of multiple hierarchical linear regression analyses (controlling for zBMI, diabetes duration, HbA1c, sex), weight bias internalization, weight-based victimization, and frequency of weight-based victimization by peers, family, and healthcare professionals were all positively associated with disordered eating. Weight stigma is an understudied but potentially important factor to address in adolescents with T1D. Reducing weight stigma may be a promising, novel target for eating disorder prevention in this population.

Experiences and opinions of adults with type 1 diabetes on the android-based open-source closed-loop system in China: a qualitative study

OBJECTIVE

As an emerging technology, Android-based open-source closed-loop system also called Android Artificial Pancreas System (AAPS), has been increasingly validated by evidence for its effectiveness in improving glycaemic outcomes, positioning it as a crucial option for managing type 1 diabetes (T1D). However, there are still only a few studies examining the experiences of using AAPS, and relevant qualitative studies have not been conducted in Asia so far. This study aimed to explore the experiences and opinions of adult patients with T1D on the AAPS.

DESIGN

Semi-structured interviews and the Insulin Dosing Systems: Perceptions, Ideas, Reflections and Expectations questionnaires were conducted among patients. The questionnaire was scored on a 100-point scale. Thematic analysis was adopted to analyse the transcribed text. Recruitment of interviewees would be halted when no new themes emerged. The scores of the questionnaire on AAPS satisfaction were calculated, and the Mann-Whitney U test was used to compare the results of different sections of the questionnaire.

SETTING

Guangdong Province in China.

PARTICIPANTS

This study recruited patients with T1D from the Guangdong T1D translational medicine study and the 'Tang Tang Quan' T1D online community in China, who participated in a clinical trial on the efficacy and safety of AAPS.

RESULTS

The study interviewed 20 adults with T1D aged 32±9.94 years. The T1D duration was 10.93±6.26 years and the glycated haemoglobin was 7.38±0.53%. Five main themes were identified: (1) expectations and feedback on AAPS; (2) impact on quality of life; (3) impact on blood glucose management; (4) user experiences; (5) suggestions for AAPS. The average score of AAPS satisfaction was 73.69 (65.94, 85.94). Mann-Whitney U test suggested that the satisfaction derived from glucose management with AAPS surpassed the satisfaction attributed to the enhancement of their overall quality of life (p<0.05).

CONCLUSIONS

Adults with T1D had generally positive experiences with AAPS. The future focus of AAPS research and development should be on optimising glycaemic management, improving device experience and reducing costs.

TRIAL REGISTRATION NUMBER

NCT05726461; Pre-results.

Spanish Validation of the Problem Area in Diabetes-Pediatric Version Survey and Its Weak Association with Metabolic Control Parameters in Pediatric Diabetes: A Cross-Sectional Multicenter Study

Background: Type 1 diabetes mellitus (T1DM) in pediatric patients often leads to emotional distress, impacting self-management. The PAID-Peds survey measures diabetes-related emotional burden but lacks a validated Spanish version. This study aimed to validate the Spanish PAID-Peds survey in children and adolescents with T1DM and correlate it with diabetic metabolic control parameters. Methods: A cross-sectional study was conducted from October 2022 to December 2023, recruiting 636 patients aged 8-17 years from three Spanish hospitals. Psychometric properties were assessed using Cronbach's alpha for reliability and confirmatory factor analysis for construct validity. Associations between PAID-Peds scores and clinical measures, such as HbA1c, were examined. Results: The final sample consisted of 538 participants (84.59% response rate). The PAID-Peds survey showed high internal consistency (Cronbach's alpha = 0.90). The confirmatory factor analysis indicated a satisfactory model fit (χ2 = 812.28, p < 0.001; RMSEA = 0.08). Weak correlations were found between PAID-Peds scores and HbA1c (r = 0.14, p < 0.001). Conclusions: The Spanish PAID-Peds survey is a reliable tool for assessing emotional burden in pediatric T1DM patients. Integrating it into clinical practice may improve early identification of emotional distress, aiding in better diabetes management. Further research should explore its application over time and in intervention studies.

The status of care for youth with type 1 diabetes within and coming from humanitarian crises settings: a narrative review

BACKGROUND

Humanitarian crises bring unique, and potentially growing challenges to people with type 1 diabetes (T1D). We aimed to determine, in youth with T1D (mean age (± 1SD) 0-17.9 years) within and coming from humanitarian crises settings (HCS), the reported prevalence that meet international consensus targets for glycaemic, blood pressure and lipid management, and incidence of severe hypoglycaemia or diabetic ketoacidosis.

METHODS

A narrative review of quantitative data was conducted, using a systematic process. MEDLINE (Ovid), Global Health, Web of Science, Scopus, Embase, CINAHL, APA PsycINFO, Cochrane trials, and the reference lists of eligible records were searched (January 2014-February 2024); ten records covering ten separate studies were retrieved.

RESULTS

Glycaemic management was consistently suboptimal in HCS. However, among individuals coming from HCS, glycaemia varied. Across both groups, data relating to blood pressure, lipids, severe hypoglycaemia or diabetic ketoacidosis were either unavailable or limited.

CONCLUSION

Findings expose the dearth of data relating to defined youth with T1D within and coming from HCS, leaving the status of this population largely uncharacterised. With limited data indicating suboptimal T1D management, there is a pressing need for the development of a consensus guideline on, and core indicators relating to such youth within and coming from HCS, plus monitoring systems and outcome data.

Screening of necroptosis-related genes and evaluating the prognostic capacity, clinical value, and the effect of their copy number variations in acute myeloid leukemia

BACKGROUND

Acute myeloid leukemia (AML) is an aggressive hematological neoplasm. Little improvement in survival rates has been achieved over the past few decades. Necroptosis has relationship with certain types of malignancies outcomes. Here, we evaluated the diagnostic ability, prognostic capacity of necroptosis-related genes (NRGs) and the effect of their copy number variations (CNVs) in AML.

METHODS

Necroptosis-related differentially expressed genes (NRDEGs) were identified after intersecting differentially expressed genes (DEGs) from the Gene Expression Omnibus(GEO) database with NRGs from GeneCards, the Molecular Signatures Database (MSigDB) and literatures. Machine learning was applied to obtain hub-NRDEGs. The expression levels of the hub-NRDEGs were validated in vitro. The mRNA-miRNA and mRNA-TF interaction networks with the hub-NRDEGs were screened using Cytoscape@. Single-sample gene set enrichment analysis (ssGSEA) was utilized to calculate correlations between the hub-NRDEGs and immune cells. CNV analysis of the hub-NRDEGs was carried out on the TCGA-LAML datasets from the TCGA database. Kaplan-Meier (K-M) survival analyses were utilized to evaluate the prognostic values along with Cox model.

RESULTS

Six hub-NRDEGs (SLC25A5, PARP1, CTSS, ZNF217, NFKB1, and PYGL) were obtained and their expression changes derived from CNVs in AML were visualized. In total, 65 mRNA-miRNA and 80 mRNA-TF interaction networks with hub-NRDEGs were screened. The ssGSEA result showed the expression of RAPR1 was inversely related to CD56dim natural killer cells and the expression of CTSS was positive related to Myeloid-derived suppressor cells (MDSCs) in AML. The K-M results demonstrated that ZNF217 had significant difference in the duration of survival in AML patients. Cox regression models revealed that the hub-NRDEGs had better predictive power at year-1 and year-5.

CONCLUSION

These screened NRDEGs can be exploited as clinical prognostic predictions in AML patients, as well as potential biomarkers for diagnosis and therapeutic targeting.

Technology usage and glycaemic outcomes in a single tertiary centre with an ethnically diverse and socioeconomically deprived cohort of children with type 1 diabetes mellitus

Background

The UK National Paediatric Diabetes Audit (NPDA) data reports disparities in Haemoglobin A1c (HbA1c) levels among children and young people (CYP) with Type 1 Diabetes (T1D), with higher levels in those of Black ethnic background and lower socioeconomic status who have less access to technology. We investigate HbA1c differences in a T1D cohort with higher than national average technology uptake where > 60% come from an ethnic minority and/or socioeconomically deprived population.

Design & methods

Retrospective cross-sectional study investigating the influence of demographic factors, technology use, and socioeconomic status (SES) on glycaemic outcomes. The study population was 222 CYP with T1D who attended the diabetes clinic in 2022 at a single tertiary paediatric diabetes centre.

Results

Among 222 CYP, 60% were of ethnic minority (Asian, Black, Mixed and Other were 32%, 12%, 6% and 10% respectively) and 40% of white heritage. 94% used Continuous Glucose Monitoring (CGM) and 60% used Continuous Subcutaneous Insulin Infusion (CSII) via open or closed loop. 6% used Self-Monitoring of Blood Glucose (SMBG) and Multiple Daily Injections (MDI), 34% used CGM and MDI, 38% used CGM and CSII and 22% used Hybrid Closed-Loop (HCL) systems. Significant differences in HbA1c across therapy groups (p < 0.001) was noted with lowest HbA1c in HCL group (55 mmol/mol; p <0.001). Despite adjusting for therapy type, the Black group had higher HbA1c than their white and Asian counterparts (p<0.001). CYP from the most deprived tertile had significantly higher HbA1c levels (p < 0.001) but the difference was not sustained after adjusting for therapy type.

Conclusion

Advanced diabetes technologies improve glycaemic control. Whilst equalising technology access mitigates socioeconomic disparities in HbA1c, CYP from Black ethnic background continue to display a higher HbA1c. The study underscores the necessity of fair technology distribution and further research into elevated HbA1c levels among Black CYP using advanced diabetes technology.

Age-standardized incidence, prevalence, mortality rates and future projections of autoimmune diseases in China: a systematic analysis based on GBD 2021

This study assessed trends in age-standardized incidence (ASIR), prevalence (ASPR), and mortality rates (ASMR) per 100,000 population for asthma, Type 1 Diabetes Mellitus (T1DM), Inflammatory Bowel Disease (IBD), Multiple Sclerosis (MS), Psoriasis, and Rheumatoid Arthritis (RA) in China from 1990 to 2021 and projected ASIR trends through 2046. Data were obtained from the Global Burden of Disease (GBD) 2021 study. Trends in ASIR, ASPR, and ASMR were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average APC (AAPC). Bayesian age-period-cohort (BAPC) modeling was applied to project future ASIR trends. In 2021, asthma had the highest ASIR (364.17/100,000), followed by psoriasis (59.70/100,000) and RA (13.70/100,000), while MS (0.16/100,000) and IBD (1.40/100,000) were the least common. Asthma exhibited significant declines in ASIR (-1.23% AAPC), ASPR (-1.49%), and ASMR (-4.4%). Conversely, T1DM showed rising ASIR (+ 1.16%) and ASPR (+ 1.15%) alongside declining ASMR (-2.62%). Psoriasis (+ 0.74%) and IBD (+ 2.09%) also showed rising ASIR. Gender differences were notable, with greater T1DM ASIR increases in males and more significant asthma improvements in females. By 2046, the ASIR of T1DM, psoriasis, and RA is projected to reach 5.8, 80.9, and 15.54 per 100,000, respectively, while asthma is expected to decline to 330.98 per 100,000. The rising ASIR and ASPR for most autoimmune diseases in China contrast with declining ASMR, highlighting the dual challenge of managing increasing disease burdens while sustaining reductions in mortality. Targeted prevention and management strategies are essential to address these evolving public health needs.