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O'Meara M, Mateus Acuña JC, Uribe A. Long-Term Benefits of an Integrated Continuous Glucose Monitoring and Insulin Pump System for Emergency Admissions, Hospitalization, and Metabolic Control in a Cohort of People With Diabetes: Retrospective Cohort Study. JMIR Diabetes 2023; 8:e46880. [PMID: 37610810 PMCID: PMC10483304 DOI: 10.2196/46880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND There is evidence in the literature that the use of sensor-augmented insulin pumps in patients with high-complexity diabetes improves metabolic control. However, there is no long-term information on clinical outcomes such as hospitalization or admission to the emergency room. This study describes outcomes for metabolic control, incidence of hospitalizations, and emergency room visits in a specific population using this technology. OBJECTIVE We aimed to assess long-term glycemic and clinical outcomes after the use of continuous subcutaneous insulin infusion and continuous glucose monitoring in people with diabetes. METHODS A retrospective cohort study was carried out in patients with diabetes previously treated with an intensive insulin regimen at a specialized diabetes treatment center who required a sensor-augmented insulin pump due to nonoptimal glycemic control. Glycated hemoglobin, severe hypoglycemic episodes, nonsevere hypoglycemic episodes, perception of hypoglycemia, and the incidence of emergency room visits and hospitalizations before and after treatment were evaluated. RESULTS Between January 2013 and August 2020, 74 patients with a median age of 36 (IQR 27-46) years were included in the study with a median 4 (IQR 2-7) years of follow-up. We found a statistically significant reduction in glycated hemoglobin (8.35% vs 7%; P<.001), nonsevere hypoglycemic episodes (71/74, 96% vs 62/74, 84%; P=.01), emergency room visits (42/73, 58% vs 4/62, 6%; P<.001), and hospitalizations (36/72, 50% vs 10/72, 14%; P<.001) after use of continuous subcutaneous insulin infusion. CONCLUSIONS The use of a sensor-augmented insulin pump associated with a strict follow-up program for patients with high-complexity diabetes led to a significant and sustained reduction in glycated hemoglobin and hypoglycemic episodes, as well as in the rate of emergency room visits and hospitalizations. These results encourage the adoption of this technology in patients who do not achieve metabolic control with optimal management of diabetes.
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Affiliation(s)
- Miguel O'Meara
- Fundación Cardioinfantil, Universidad del Rosario, Programa Diabetes de alta complejidad, Compensar Entidad Promotora de salud, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan Camilo Mateus Acuña
- Fundación Cardioinfantil, Universidad del Rosario, Programa Diabetes de alta complejidad, Compensar Entidad Promotora de salud, Bogotá, Colombia
- Clínica Los Cobos Medical Center, Universidad del Bosque, Bogotá, Colombia
| | - Andrea Uribe
- Fundación Cardioinfantil, Universidad del Rosario, Programa Diabetes de alta complejidad, Compensar Entidad Promotora de salud, Bogotá, Colombia
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A simulator with realistic and challenging scenarios for virtual T1D patients undergoing CSII and MDI therapy. J Biomed Inform 2022; 132:104141. [PMID: 35835439 DOI: 10.1016/j.jbi.2022.104141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
In silico simulations have become essential for the development of diabetes treatments. However, currently available simulators are not challenging enough and often suffer from limitations in insulin and meal absorption variability, which is unable to realistically reflect the dynamics of people with type 1 diabetes (T1D). Additionally, T1D simulators are mainly designed for the testing of continuous subcutaneous insulin infusion (CSII) therapies. In this work, a simulator is presented that includes a generated virtual patient (VP) cohort and both fast- and long-acting Glargine-100 U/ml (Gla-100), Glargine-300 U/ml (Gla-300), and Degludec-100 U/ml (Deg-100) insulin models. Therefore, in addition to CSII therapies, multiple daily injections (MDI) therapies can also be tested. The Hovorka model and its published parameter probability distributions were used to generate cohorts of VPs that represent a T1D population. Valid patients are filtered through restrictions that guarantee that they are physiologically acceptable. To obtain more realistic scenarios, basal insulin profile patterns from the literature have been used to identify variability in insulin sensitivity. A library of mixed meals identified from real data has also been included. This work presents and validates a methodology for the creation of realistic VP cohorts that include physiological variability and a simulator that includes challenging and realistic scenarios for in silico testing. A cohort of 47 VPs has been generated and in silico simulations of both CSII and MDI therapies were performed in open-loop. The simulation outcome metrics were contrasted with literature results.
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Tsarkova P, Chakarova N, Dimova R, Grozeva G, Todorova A, Serdarova M, Salkova M, Tankova T. CSII is related to more stable glycemia in adults with type 1 diabetes. Endocrine 2022; 75:776-780. [PMID: 34694598 DOI: 10.1007/s12020-021-02913-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the present study was to compare the basic glycemic control parameters-HbA1c, CV%, and hypoglycemia, as well as quality of life and depression score in patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI). METHODS 324 adult patients with type 1 diabetes-146 using CSII and 178 on MDI, were enrolled in this cross-sectional study. HbA1c was assessed in whole blood by immuno-turbidimetric NGSP certified method. CV% was derived from CGM or was calculated from a 9-point capillary blood glucose profile. Hypoglycemia frequency, severity, and awareness were assessed using Clarke's hypoglycemia questionnaire. Quality of life (QOL) was assessed using a questionnaire by the Psychiatric Research Unit and the CES-D scale. RESULTS CSII group compared to MDI group showed significantly lower HbA1c-7.3% (6.6-8.0%) vs 8.2% (7.2-9.6%) (p < 0.0001), lower CV 27.2% (±9.8) vs 34.7% (±11.3) (p < 0.0001), fewer hypoglycemia episodes (p < 0.0001). There was no significant difference in the frequency of severe hypoglycemia, hypoglycemia awareness, QOL, and depression scores between the two groups. CONCLUSIONS CSII in type 1 diabetes is related to better and more stable glycemic control compared to MDI.
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Affiliation(s)
- Polina Tsarkova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria.
| | - Nevena Chakarova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Rumyana Dimova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Greta Grozeva
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Ani Todorova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Mina Serdarova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Martina Salkova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Tsvetalina Tankova
- Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
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Longo M, Scappaticcio L, Petrizzo M, Castaldo F, Sarnataro A, Forestiere D, Caiazzo F, Bellastella G, Maiorino MI, Capuano A, Esposito K. Glucose control in home-isolated adults with type 1 diabetes affected by COVID-19 using continuous glucose monitoring. J Endocrinol Invest 2022; 45:445-452. [PMID: 34482534 PMCID: PMC8418789 DOI: 10.1007/s40618-021-01669-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE This study is aimed at evaluating changes in metrics of glucose control in home-isolated patients with type 1 diabetes and COVID-19 using a continuous glucose monitoring (CGM) system. METHODS We included adults aged 18-45 years with type 1 diabetes, using CGM, followed by telemedicine at a Southern Italian University Hospital. Thirty-two home-quarantined subjects with SARS-CoV-2 positive swab constituted the COVID-19 group. Thirty age-matched diabetic individuals without COVID-19 formed the control group. The effects of COVID-19 on glycemic control in patients infected were assessed at different time points [2 weeks before-COVID-19 (Time 1), 2 weeks during-COVID-19 (Time 2) and 2 weeks after COVID-19 (Time 3)] and compared with those without infection. RESULTS A significant reduction of TIR (Time 1 vs Time 2, %, 60.1 ± 16.6 vs 55.4 ± 19.2, P = 0.03), associated with a significant increase of TAR level 2 (10.1 ± 7.3 vs 16.7 ± 12.9, P < 0.001), GMI (7.1 ± 0.6 vs 7.5 ± 0.8, P < 0.001), CV (37.3 ± 7.1 vs 39.6 ± 7.0, P = 0.04), mean glucose values (mg/dL, 160.2 ± 26.5 vs 175.5 ± 32.6, P = 0.001) and standard deviation (59.2 ± 13.1 vs 68.6 ± 17.7, P = 0.001) was observed in patients with COVID-19. No significant change of glycemic metrics was found in the NO COVID-19 group across the time. CONCLUSION Young home-isolated patients with type 1 diabetes and COVID-19 showed a worsening of glucose control during COVID-19, as compared with age-matched diabetic subjects without the infection.
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Affiliation(s)
- M Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - L Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - M Petrizzo
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Castaldo
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - A Sarnataro
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - D Forestiere
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - F Caiazzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - G Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - M I Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy.
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy.
| | - A Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - K Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
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Longo M, Scappaticcio L, Castaldo F, Sarnataro A, Carbone C, Caruso P, Maiorino MI, Bellastella G, Esposito K. Sexual dysfunctions in young women with type 1 diabetes and high glucose variability: findings from the METRO study. J Endocrinol Invest 2020; 43:1823-1825. [PMID: 32462315 DOI: 10.1007/s40618-020-01302-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Division of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - L Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Castaldo
- Division of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - A Sarnataro
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Carbone
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Division of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - P Caruso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M I Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
- Unit of Diabetes, AOU University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - G Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Division of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - K Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Unit of Diabetes, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
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Veloso DLC, Nascimento RCG, Leite EB, de Avila Santana L, Amato AA. Predictors of sudomotor dysfunction in patients with type 1 diabetes without clinical evidence of peripheral neuropathy. Diabetes Res Clin Pract 2020; 170:108500. [PMID: 33068659 DOI: 10.1016/j.diabres.2020.108500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/09/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022]
Abstract
AIM To investigate the frequency of foot sudomotor dysfunction determined by the electrochemical skin conductance test (ESC) and its independent predictors in individuals with type 1 diabetes mellitus (T1D) and no clinical evidence of diabetic peripheral neuropathy (DPN). METHODS Adults with T1D for longer than 5 years and without DPN defined by the Michigan Neuropathy Screening Instrument and Neuropathy Disability Score were assessed for foot sudomotor dysfunction by ESC. Multivariate logistic regression analysis was used to examine the association between foot sudomotor dysfunction (ESC < 70 µS) and demographic, clinical, and biochemical variables. RESULTS A total of 61 individuals with T1D were included. Their mean age was 29.5 ± 8.6 years, and mean diabetes duration was 17.8 ± 7.9 years. Foot sudomotor dysfunction was present in 16 (26.2%) participants, despite no clinical evidence of DPN. Retinopathy, hand sudomotor dysfunction and glycated haemoglobin (HbA1c) levels were identified as independent predictors of foot sudomotor dysfunction by multivariate logistic regression analysis. Retinopathy, hand sudomotor dysfunction, and every 1% increase of HbA1c increased the odds of foot sudomotor dysfunction by 2.48, 2.82, and 1.24-fold, respectively. CONCLUSION Our findings indicate a high frequency of foot sudomotor dysfunction among individuals with T1D and no overt DPN. Factors associated with DPN, including retinopathy and higher HbA1c levels, independently predicted the occurrence of sudomotor dysfunction, suggesting that ESC assessment is a useful tool in the clinical setting to identify early small-fiber neuropathy.
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Affiliation(s)
- Danyelle Lorrane Carneiro Veloso
- Health Sciences Teaching and Research Foundation, Federal District, Brasilia, Brazil; Postgraduate Program in Health Sciences, University of Brasilia, Brazil
| | | | - Eliziane Brandao Leite
- Health Sciences Teaching and Research Foundation, Federal District, Brasilia, Brazil; State Health Secretary of the Federal District, Brazil
| | | | - Angelica Amorim Amato
- Postgraduate Program in Health Sciences, University of Brasilia, Brazil; Laboratory of Molecular Pharmacology, School of Health Sciences, University of Brasilia, Brazil.
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Longo M, Cirillo P, Scappaticcio L, Tomasuolo M, Pernice V, Caruso P, Bellastella G, Maiorino MI, Esposito K. Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases. J Sex Med 2020; 18:219-223. [PMID: 33223430 DOI: 10.1016/j.jsxm.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/03/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Female sexual dysfunctions (FSDs) are frequent concerns in women with type 1 diabetes (T1D), which is frequently associated with other autoimmune diseases (ADs). AIM To assess sexual function in young type 1 diabetic women with or without additional ADs. METHODS Women with T1D aged 18-35 years with a stable couple relationship and no oral contraceptive use were enrolled. Diabetic women with concomitant ADs were also identified. All women completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale. OUTCOMES The main outcome was the prevalence of FSD. The FSFI-single domain scores were also evaluated in diabetic women with or without additional ADs. RESULTS The global population included 154 diabetic women, of whom 66 (42%) had at least one additional AD. The prevalence of FSD was similar among diabetic women with and those without (30% vs 32%, P = .980) additional ADs. The FSFI-desire score was significantly lower among diabetic women with concomitant ADs than those without ADs [median (interquartile range), 4.1 (3.6, 4.8) vs 4.6 (4.0, 5.0), P = .042]. CLINICAL IMPLICATIONS An early evaluation of sexual function in women with T1D and concomitant ADs should be encouraged. STRENGTHS & LIMITATIONS Major strengths are the use of 2 validated tools to diagnose FSD and the relatively large number of subjects investigated. The limitations include the cross-sectional nature of the study, which does not allow to make inference regarding the cause and effect. CONCLUSION Diabetic women with additional ADs show an impairment in sexual desire as compared with those suffering only from diabetes. Longo M, Cirillo P, Scappaticcio L, et al. Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases. J Sex Med 2021;18:219-223.
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Affiliation(s)
- Miriam Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Tomasuolo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vlenia Pernice
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Caruso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
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Real-world outcomes of insulin pump compared to multiple daily injection therapy in adult type 1 diabetes mellitus patients in a Mediterranean scenario. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00887-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Longo M, Caruso P, Petrizzo M, Castaldo F, Sarnataro A, Gicchino M, Bellastella G, Esposito K, Maiorino MI. Glycemic control in people with type 1 diabetes using a hybrid closed loop system and followed by telemedicine during the COVID-19 pandemic in Italy. Diabetes Res Clin Pract 2020; 169:108440. [PMID: 32926958 PMCID: PMC7486201 DOI: 10.1016/j.diabres.2020.108440] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022]
Abstract
AIMS This study aims at evaluating the metrics of glycemic control in people with type 1 diabetes using the hybrid closed loop (HCL) system during the COVID-19 lockdown. METHODS This is a retrospective study of thirty adults with type 1 diabetes using HCL and followed with telemedicine at an Italian University Hospital. Data on metrics of glucose control were collected at different times: two weeks before the lockdown (Time 0), first two weeks of lockdown (Time 1), last two weeks of lockdown (Time 2) and first two weeks after the lockdown (Time 3). The primary endpoint was the change in glucose management indicator (GMI) across the different time points. RESULTS GMI did not worsen over time (Time 1 vs Time 3, 7% vs 6.9%, P < 0.05), whereas a reduction of mean glucose (P = 0.004) and indices of glucose variability was observed. Time in range (TIR) significantly increased (68.5% vs 73.5%, P = 0.012), and time above range (TAR) level 2 (251-400 mg/dL) significantly decreased (P = 0.002). The improvement of TIR and glucose variability was mainly observed in participants < 35 years. CONCLUSIONS Adults with type 1 diabetes using HCL showed a significant improvement of most of the metrics of glucose control during the COVID-19 lockdown.
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Affiliation(s)
- Miriam Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Paola Caruso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Michela Petrizzo
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Filomena Castaldo
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Sarnataro
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Maurizio Gicchino
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Zabeen B, Nahar J, Islam N, Azad K, Donaghue K. Effects of Continuous Subcutaneous Insulin Infusion on Glycaemic Control and Acute Complications in Young People with Type 1 Diabetes in Bangladesh. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2020. [DOI: 10.1159/000511241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> The objective of this study was to assess the effects of continuous subcutaneous insulin infusion (CSII) therapy on glycaemic control and acute complications in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). <b><i>Methods:</i></b> The prospective observational study was done in patients on multiple daily injection (MDI) switching to pump system. All patients were followed at the Paediatric Diabetes Clinic at BIRDEM Hospital. They were trained on carbohydrates counting and started on continuous basal insulin infusion in addition to meal and high blood glucose correction insulin boluses. They were followed on insulin pump therapy for a 6-month period. <b><i>Results:</i></b> Twenty patients were analysed, from baseline to visit 2 after 6 months. The patients included in the study had T1DM for a mean duration of 4.7 ± 3.1 years. The age ranged from 3 to 25 years (mean 13.7 ± 6.1). There was 1% reduction in haemoglobin A1c (HbA1c) after 6 months, though it did not reach the statistical significance (<i>p</i> = 0.084). There was significant reduction of mean fasting blood glucose level 13.4 ± 7.0 versus 6.9 ± 1.6 mmol/L (<i>p</i> = 0.001), total insulin requirement (<i>p</i> = 0.043), frequency of hypoglycaemic episodes (<i>p</i> = 0.006), and diabetic ketoacidosis (<i>p</i> = 0.002) events during CSII therapy. <b><i>Conclusion:</i></b> In our study, we found that switching young T1DM patients from MDI to insulin pump had been effective with achievement of a reduction in fasting blood glucose, HbA1c, and acute complications.
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Abstract
BACKGROUND Advances in pump technology have increased the popularity of this treatment modality among patients with type 1 diabetes and recently also among patients with type 2 diabetes. AREAS OF UNCERTAINTY Four decades after the incorporation of the insulin pump in clinical use, questions regarding its efficacy, occurrence rate of short-term complications as hypoglycemia and diabetes ketoacidosis, timing of pump initiation, and selected populations for use remain unanswered. DATA SOURCES A review of the literature was performed using the PubMed database to identify all articles published up till December 2018, with the search terms including insulin pump therapy/continuous subcutaneous insulin delivery. The Cochrane database was searched for meta-analysis evaluating controlled randomized trials. Consensuses guidelines published by the International Society for Pediatric and Adolescent Diabetes, American Diabetes Association, and Advanced Technologies and Treatments for Diabetes year books were additionally reviewed for relevant cited articles. THERAPEUTIC ADVANCES Insulin pump therapy offers flexible management of diabetes. It enables adjustment of basal insulin to daily requirements and circadian needs, offers more precise treatment for meals and physical activity, and, when integrated with continuous glucose monitoring, allows glucose responsive insulin delivery. The ability to download and transmit data for analysis allow for treatment optimization. Newer pumps are simple to operate and increase user experience. Studies support the efficacy of pump therapy in improving glycemic control and reducing the occurrence of hypoglycemia without increasing episodes of diabetes ketoacidosis. They also improve quality of life. Recent evidence suggests a role for pump therapy in reducing microvascular and macrovascular diabetes-related complications. CONCLUSIONS Insulin pump therapy appears to be effective and safe in people with T1D regardless of age. Future advancements will include incorporation of closed loop and various decision support systems to aid and improve metabolic control and quality of life.
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Kesavadev J, Saboo B, Krishna MB, Krishnan G. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. Diabetes Ther 2020; 11:1251-1269. [PMID: 32410184 PMCID: PMC7261311 DOI: 10.1007/s13300-020-00831-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 12/24/2022] Open
Abstract
The year 2021 will mark 100 years since the discovery of insulin. Insulin, the first medication to be discovered for diabetes, is still the safest and most potent glucose-lowering therapy. The major challenge of insulin despite its efficacy has been the occurrence of hypoglycemia, which has resulted in sub-optimal dosages being prescribed in the vast majority of patients. Popular devices used for insulin administration are syringes, pens, and pumps. An artificial pancreas (AP) with a closed-loop delivery system with > 95% time in range is believed to soon become a reality. The development of closed-loop delivery systems has gained momentum with recent advances in continuous glucose monitoring (CGM) and computer algorithms. This review discusses the evolution of syringes, disposable, durable pens and connected pens, needles, tethered and patch insulin pumps, bionic pancreas, alternate controller-enabled infusion (ACE) pumps, and do-it-yourself artificial pancreas systems (DIY-APS).
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Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India.
| | | | - Meera B Krishna
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
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13
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Almogbel E. Impact of insulin pump therapy on glycemic control among adult Saudi type-1 diabetic patients. An interview-based case-control study. J Family Med Prim Care 2020; 9:1013-1019. [PMID: 32318460 PMCID: PMC7114031 DOI: 10.4103/jfmpc.jfmpc_869_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/13/2019] [Accepted: 12/27/2019] [Indexed: 12/14/2022] Open
Abstract
Context: Diabetes is associated with several potential preventable complications like the efficacy of insulin pump over multiple daily insulin injections (MDI) in glycemic control. Aims: To assess the outcomes of insulin pump as compared to insulin injection therapy. Setting and Design: Case-control study conducted among adult type-1 diabetic patients using insulin pump therapy and alternative insulin injection therapy from the University Diabetes Center (UDC), King Saud University, Riyadh, Saudi Arabia during 1st June–30th October, 2017. Materials and Methods: Interview-based questionnaires were used on of 200 subjects using insulin therapy and control (conventional and MDI). Results of each were compared. Statistical Analysis Used: t-test was used for continuous variables and Chi-square test was used for categorical variables. P value less than 0.05 was considered statistically significant. Results: Patients on pump therapy showed a non-significant higher mean of hypoglycemic episodes per week and a lower mean of diabetic ketoacidosis (DKA) episodes per year as compared to the injection therapy patients 1.97 vs. 1.77 and 0.35 vs. 0.37, respectively. However, statistically significant differences were found between the pump and MDI, the pump and conventional, and the MDI and conventional when HbA1c levels were tested. Conclusion: Among adult patients with type-1 diabetes, insulin pump as compared to insulin injection was associated with better glycemic control. However, for acute complications, non-significant higher mean of hypoglycemic episodes per week and a lower mean of DKA episodes per year were reported in pump therapy as compared to the injection therapy patients.
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Affiliation(s)
- Ebtehal Almogbel
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
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Wardian JL, True MW, Folaron I, Colburn J, Tate JM, Beckman DJ. The Choice Should Be Yours: Diabetes-Related Distress by Insulin Delivery Method for People with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:42-47. [PMID: 31418594 DOI: 10.1089/dia.2019.0228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: American Diabetes Association (ADA) recommends psychosocial assessment for people with diabetes, including diabetes-related distress. Elevated diabetes-related distress is associated with poor self-management, lower medication adherence, and poorer quality of life. Insulin delivery methods are multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Because people with type 1 diabetes mellitus (T1DM) require comprehensive insulin therapy to manage blood glucose, we explored the association of insulin delivery methods and diabetes distress in this group. Methods: The U.S. Air Force Diabetes Center of Excellence (DCOE), a specialty clinic for adults who are Military Health System beneficiaries, administers the validated 17-item Diabetes-related Distress Scale (DDS-17) as part of standard care. Patient data were analyzed from June 2015 to August 2016 using SPSS version 22. Patients were free to choose the method of insulin delivery with minimal or no additional cost. Results: There were 203 patients with T1DM who completed the DDS-17 as part of standard care during the time period. Patients were categorized as CSII (57.6%) or MDI (42.4%). Women were significantly more likely to choose MDI over CSII than men (P = 0.003). DDS-17 scores were low in both groups, and there were no significant differences in DDS-17 by insulin delivery method. Furthermore, no significant differences were found in hemoglobin A1c (HbA1c) between CSII (7.9% or 63 mmol/mol) and MDI (8.1% or 65 mmol/mol) users (P = 0.22) and no significant differences in body mass index (BMI) between patients using CSII (M = 28.33 kg/m2) and MDI (28.49 kg/m2) users (P = 0.15). Conclusions: Our study demonstrated that if patients are relatively free to choose the insulin delivery method (minimal or no financial constraints), there were no differences in diabetes distress scores, HbA1c, or BMI between CSII and MDI. Therefore, people with T1DM may benefit from choosing the method of insulin delivery that will enable them to achieve individual goals and manage diabetes-related distress.
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Affiliation(s)
- Jana L Wardian
- Diabetes Center of Excellence, Wilford Hall Medical Center, JBSA-Lackland Air Force Base, Texas
| | - Mark W True
- Division of Endocrinology, San Antonio Military Medical Center, JBSA-Ft. Sam Houston, Texas
| | - Irene Folaron
- Division of Endocrinology, San Antonio Military Medical Center, JBSA-Ft. Sam Houston, Texas
| | - Jeff Colburn
- Division of Endocrinology, San Antonio Military Medical Center, JBSA-Ft. Sam Houston, Texas
| | - Joshua M Tate
- Division of Endocrinology, San Antonio Military Medical Center, JBSA-Ft. Sam Houston, Texas
| | - Darrick J Beckman
- Diabetes Center of Excellence, Wilford Hall Medical Center, JBSA-Lackland Air Force Base, Texas
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Longo M, Scappaticcio L, Bellastella G, Pernice V, Cirillo P, Maio A, Castaldo F, Giugliano D, Esposito K, Maiorino MI. Alterations in the Levels of Circulating and Endothelial Progenitor Cells Levels in Young Adults with Type 1 Diabetes: A 2-Year Follow-Up from the Observational METRO Study. Diabetes Metab Syndr Obes 2020; 13:777-784. [PMID: 32256094 PMCID: PMC7090196 DOI: 10.2147/dmso.s238588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/30/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Type 1 diabetes is associated with high risk of cardiovascular disease (CVD). Reduced levels of circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) have been indicated as a risk factor for adverse cardiovascular outcomes and death in people at high cardiovascular risk. The aim of the present study was to evaluate the change in CPCs and EPCs levels in a population of young type 1 diabetic patients treated with intensive insulin regimen over a period of 2 years. PATIENTS AND METHODS A total of 204 type 1 diabetic patients, of whom 84 treated with insulin pump (CSII) and 120 with multiple daily insulin injections (MDI), completed a 2-year follow-up. Clinical measurements, including the indices of glycemic control and glucose variability, were collected at baseline and after 2 years. Both CPC and EPC cell count were assessed by flow cytometry. RESULTS Mean age of participants was 24.5 years and mean diabetes duration was 13.6 years. After 2 years, we found a significant reduction of HbA1c (-0.3% versus baseline, P <0.001), associated with decrease in mean amplitude of glucose excursion (MAGE) (-0.5 mmol/L versus baseline, P<0.001), continuous overall net glycemic action (CONGA) (-0.2 mmol/L versus baseline, P=0.006), and blood glucose standard deviation (BGSD) (-0.2 mmol/L versus baseline, P<0.001). The number of all EPCs phenotypes, but not CPC cell count, significantly raised up in the entire population, with higher increase in CSII group. MAGE resulted as an independent predictor for increased levels of both CD34+ (P = 0.020) and CD34+KDR+ (P = 0.004) cell count in the whole population. CONCLUSION Over a 2-year follow-up, young type 1 diabetic patients showed an increase in circulating EPCs levels, which was higher in patients with CSII. Glucose variability resulted as an independent predictor of the raised levels of EPCs in this selected population.
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Affiliation(s)
- Miriam Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Vlenia Pernice
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Paolo Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Antonietta Maio
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Filomena Castaldo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Dario Giugliano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Unit of Diabetes, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples80138, Italy
- Correspondence: Maria Ida Maiorino Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples80138, ItalyTel +39 0815665289Fax +39 0815665032 Email
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Cipponeri E, Blini C, Lamera C, De Mori V, Veronesi G, Bossi AC. Insulin Management for Type 1 Diabetic Patients During Social Alcohol Consumption: The SPRITZ Study. Curr Diabetes Rev 2020; 16:619-627. [PMID: 32552634 DOI: 10.2174/1573399815666190507121332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is no data available on the best insulin treatment to counteract the effects of glucose excursions due to a moderate alcohol intake associated with portions of slight fat and protein-containing food, as often the case during social happenings or "happy hours". INTRODUCTION This study analyzes the glycemic control and quality of life in 8 adult type 1 diabetic (T1D) patients on insulin-pump therapy which were invited to consume a traditional Italian aperitif ("Spritz" and chips). METHODS Patients consumed Spritz aperitif twice: using their habitual bolus, based on carbohydrates (CHO) counting (V1), or with a personalized, advanced bolus (V2) calculated from insulin/Kcal derived from Fats and Proteins (FPU). Post-prandial glucose was continuously monitored; glucose incremental areas (iAUC), glucose peak and time to peak, and estimated change from V1 to V2 from repeated- measures models were computed. Each patient fulfilled validated questionnaires on quality of life, knowledge about diabetes and CHO counting. RESULTS After the educational program, a reduced iAUC (0-80 min: -306, p=ns; 40-80 min: -400, p=0.07) due to greater (p=0.03) and prolonged double-wave insulin boluses was observed. Blood glucose peak and time to peak were also reduced. Moreover, improvements in the psycho-affective dimension, as well as in the alimentary knowledge were detected. CONCLUSION Therefore, a personalized educational program on CHO + FPU counting together with insulin bolus management can improve glycemic control during social consumption of alcohol, with positive reflections on the psycho-affective dimension. Further studies are mandatory to confirm such preliminary results.
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Affiliation(s)
- Elisa Cipponeri
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Cesare Blini
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Christian Lamera
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Valentina De Mori
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Giovanni Veronesi
- Research Centre EPIMED - Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Carlo Bossi
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
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Yao MY, Li LQ, Ma JX, Xue P, Li YK. Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study. ACTA ACUST UNITED AC 2019; 53:e8652. [PMID: 31859911 PMCID: PMC6915907 DOI: 10.1590/1414-431x20198652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4–10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (–0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [–2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.
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Affiliation(s)
- Ming-Yan Yao
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Endocrinology, Baoding NO.1 Central Hospital, Baoding, Hebei, China
| | - Li-Qin Li
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian-Xia Ma
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Xue
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yu-Kun Li
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Short-term glucose variability in adults with Type 1 diabetes does not differ between insulin pump and multiple daily injection users - a masked continuous glucose monitoring study in clinical practice. DIABETES & METABOLISM 2018; 46:172-174. [PMID: 29937359 DOI: 10.1016/j.diabet.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/07/2018] [Accepted: 05/23/2018] [Indexed: 11/23/2022]
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