Glycaemic control across the lifespan in a cohort of New Zealand patients with type 1 diabetes mellitus

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.

Psychological distress in Aotearoa New Zealand adults with type 1 diabetes

The psychological burden of type 1 diabetes (T1D) can negatively impact health outcomes. This study evaluates the prevalence of low mood (WHO-5), disordered eating (DEPS-R), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II), in a sample of 250 New Zealand adults (8.4% Māori/91.6% non-Māori; 43.6% female/56.4% male) with T1D using validated tools. Māori and female patients indicated low mood, with lower median WHO-5 scores than non-Māori (p = 0.027) and males (p = 0.002). Māori were more likely to score in the clinical range on the WHO-5, DEPS-R, PAID and HFS-II (all p < 0.05). HbA1c was correlated with emotional well-being (rs = -0.189), diabetes distress (rs = 0.223) and disordered eating (rs = 0.389; all p < 0.001) whilst DEPS-R correlated with age (rs = -0.232) and BMI (rs = 0.343; both p ≤ 0.001). Thus, diabetes-related psychological distress is common in New Zealand adults with T1D, particularly for Māori, females and those with elevated HbA1c levels.

Epidemiology of Diabetic Ketoacidosis in the Waikato Region of New Zealand: 2000-2019

Aims

Diabetic ketoacidosis (DKA) is not well characterised in New Zealand. This study is aimed at characterising the change in epidemiology and severity of DKA from 2000 to 2019 at a tertiary hospital in the Waikato region of New Zealand.

Methods

A retrospective clinical data review of all patients admitted to Waikato District Health Board hospitals with DKA was undertaken. Characteristics and severity of DKA were assessed by type of DKA admission (diagnosed at admission, nonrecurrent, and recurrent), ethnicity, social deprivation, intensive care unit (ICU) admission, and length of hospital stay, with linear regression reporting on changes over time.

Results

There were 1254 admissions for DKA (564 individual patients), two-thirds being recurrent events. Nonrecurrent DKA patients were younger, whilst recurrent admissions for DKA were associated with T1D, female gender, greater socioeconomic deprivation, and rural living (all P values < 0.01). DKA admission increased 8-fold between 2000 and 2019, mostly due to an increased number of recurrent events, particularly in Māori and female patients (P < 0.001). ICU admissions increased over time (P < 0.001) whilst length of hospital stay trended down (P = 0.031).

Conclusions

The rise in recurrent DKA is concerning, particularly in youth and indigenous Māori. Healthcare inequities need to be addressed, including adequate access to mental health support to ensure optimal outcomes for all patients with diabetes.

Socioeconomic deprivation and cardiometabolic risk factors in individuals with type 1 diabetes: T1D exchange clinic registry

AIMS

Social determinants of health (SDOH) influence cardiovascular health in the general population; however, the degree to which this occurs in individuals with type 1 diabetes (T1D) is not well understood. We evaluated associations among socioeconomic deprivation and cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index, physical activity) in individuals with T1D from the T1D Clinic Exchange Registry.

METHODS

We evaluated the association between the social deprivation index (SDI) and cardiometabolic risk factors using multivariable and logistic regression among 18,754 participants ages 13 - 90 years (mean 29.2 ± 17) in the T1D Exchange clinic registry from 6,320 zip code tabulation areas (2007-2017).

RESULTS

SDI was associated with multiple cardiometabolic risk factors even after adjusting for covariates (age, biological sex, T1D duration, and race/ethnicity) in the multivariable linear regression models. Those in the highest socially deprived areas had 1.69 (unadjusted) and 1.78 (adjusted) times odds of a triple concomitant risk burden of poor glycemia, dyslipidemia, and hypertension.

CONCLUSIONS

Persistent SDOH differences could account for a substantial degree of poor achievement of cardiometabolic targets in individuals with T1D. Our results suggest the need for a broader framework to understand the association between T1D and adverse cardiometabolic outcomes.

Medical Certification of Pilots Through the Insulin-Treated Diabetes Mellitus Protocol at the FAA

INTRODUCTION: In 2019, the Federal Aviation Administration (FAA) announced a protocol to evaluate pilots with insulin treated diabetes mellitus (ITDM) for special issuance (SI) medical certification for first-/second-class pilots. The protocol’s aim is improved assessment of ITDM control/hypoglycemia risk and relies on continuous glucose monitoring (CGM) data. This study compares the characteristics of first-/second-class pilots with ITDM and certification outcome.METHODS: Data was collected retrospectively from the FAA Document Imaging Workflow System (DIWS) for pilots considered for a first-/second-class SI under the ITDM program between November 2019 and October 2021. Inclusion criteria required submission of information required for certification decision (SI vs. denial). We extracted data on demographics and CGM parameters including mean glucose, standard deviation, coefficient of variance, time in range (%), time > 250 mg · dl−1 (%), and time < 70–80 mg · dl−1 (%). We compared these parameters between pilots issued an SI vs. denial with Mann-Whitney U-tests and Fisher exact tests using R.RESULTS: Of 200 pilots with ITDM identified, 77 met inclusion criteria. Of those, 55 received SIs and 22 were denied. Pilots issued SI were statistically significantly older (46 vs. 27 yr), had a lower hemoglobin A1c (6.50% vs. 7.10%), lower average glucose (139 mg · dl−1 vs. 156 mg · dl−1), and spent less time with low glucose levels (0.95% vs. 2.0%).DISCUSSION: The FAA program has successfully medically certificated pilots with ITDM for first-/second-class. Pilots granted an ITDM SI reflect significantly better diabetes control, including less potential for hypoglycemia. As this program continues, it will potentially allow previously disqualified pilots to fly safely.Stanwyck LK, DeVoll JR, Pastore J, Gamble Z, Poe A, Gui GV. Medical certification of pilots through the insulin-treated diabetes mellitus protocol at the FAA. Aerosp Med Hum Perform. 2022; 93(8):627–632.

Potential of PKM2 as a drug target in mouse models with type 1 diabetes mellitus

BACKGROUND

This study aimed to determine the effect of PKM2 knockout in STZ induced type 1 diabetes mellitus (T1D) mouse models and to explore the possible mechanism.

METHOD

PKM2fl/fl C57BL/6 mouse was backcrossed with Ins-1cre C57BL/6 mouse to generate β-cell-specific PKM2 knockout mouse after tamoxifen administration. The expression level of PKM2 in pancreas tissues was detected by quantitative reverse-transcription polymerase chain reaction and western blot analysis. The blood glucose levels in STZ induced T1D mouse models were measured to validate the establishment of T1D models. The pathological changes of T1D mouse were examined by hematoxylin and eosin. The oxidative stress (OS) and inflammatory response in T1D mouse were determined by measuring the expression levels of malondialdehyde, superoxide dismutase, and 8-OHdG in pancreatic tissues and the serum levels of interleukin-6 and tumor necrosis factor-α. The ability to catabolize glucose was assessed through intraperitoneal glucose tolerance test and insulin tolerance test.

RESULTS

β-cell-specific PKM2 knockout was successfully achieved in PKM2fl/flcre+ mouse. T1D mouse with PKM2 knockdown had decreased blood glucose level and suppressed cell apoptosis. PKM2 knockout in T1D mouse attenuated β cell injury. OS and inflammatory response in T1D mouse with PKM2 knockout were also suppressed compared with T1D mouse without PKM2 knockout.

CONCLUSION

PKM2 knockout in T1D mouse can attenuate OS and inflammatory response as well as decrease blood glucose level, suggesting the potential of PKM2 as a drug target for T1D treatment.

The psychological profile of youth and young adults with type 1 diabetes in New Zealand

BACKGROUND

The psychological status of New Zealanders living with type 1 diabetes (T1D) is unknown. This study's purpose is to determine the prevalence of general wellbeing, diabetes-specific distress, and disordered eating, and explore their relationships with glycemic control.

METHODS

Participants were patients aged 15-24 years with T1D (N = 200) who attended their routine multidisciplinary clinic at the Waikato Regional Diabetes Service. They completed questionnaires including the World Health Organization Well-Being Index, the Problem Areas in Diabetes scales, and the Diabetes Eating Problem Survey-Revised. Clinical and demographic information were also collected.

RESULTS

Median age of participants was 19.3 years and 14% identified as Māori (indigenous people of Aotearoa New Zealand). Median HbA1c was 73 mmol/mol. One fifth of participants experienced low emotional wellbeing, including 7.5% who experienced likely depression. Diabetes distress was found in 24.1%, and 30.7% experienced disordered eating behaviors. Differences were identified between Māori and non-Māori in measures of diabetes distress and disordered eating, with Māori more likely to score in clinically significant ranges (50% vs. 19.9%; 53.6% vs. 26.7%, p < 0.05). Disordered eating was correlated with Hb_A1c , body mass index, and social deprivation; diabetes distress was associated with Hb_A1c and inversely with age (all p < 0.05).

CONCLUSIONS

This study is the first of its kind to determine that New Zealanders living with T1D experience significant psychological distress. Research with larger Māori representation is needed to more closely review identified inequities. Replication in other local clinics will help contribute to the ongoing development of normative data for Aotearoa New Zealand.

Sex differences over time for glycemic control, pump use and insulin dose in patients aged 10-40 years with type 1 diabetes: a diabetes registry study

INTRODUCTION

To evaluate sex differences in people with type 1 diabetes concerning changes in glycemic control and trends in insulin pump use and insulin dose over two decades in adolescents and one-and-a-half decades in adults.

RESEARCH DESIGN AND METHODS

People aged 10-20 years (data years 1999-2018) and 21-40 years (data years 2004-2018) with type 1 diabetes were identified in the Diabetes Prospective Follow-up Registry (DPV). All available patients' data sets of the respective period were used for linear regression analyses to investigate trends in HbA1c, pump use, insulin doses and body mass index SD scores (BMI-SDS) in females and males. In addition, stratification by migrant background was made for the adolescent group.

RESULTS

In the youth group (n=68 662), both boys and girls showed an HbA1c decrease over the period examined. After stratification for migrant background, an HbA1c convergence between boys and girls was seen in those without migrant background as of 2016. Usage of insulin pumps increased continuously from 3% (boys and girls) to 47% (boys) and 54% (girls), respectively. The daily insulin dose in units per kilogram body weight and day increased continuously from 1999 to 2018. An insulin dose leveling between boys and girls occurred. BMI-SDS consistently increased in girls whereas only slight variations were observed in boys.The adult group (n=15 380) showed constant HbA1c sex differences from 2004 to 2018 with lower HbA1c level in females. The use of insulin pump therapy rose from 18% to 35% (males) and 30% to 50% (females).

CONCLUSIONS

The gap in metabolic control between boys and girls with type 1 diabetes seems to close, but predominantly in adolescents without a migrant background. Improved HbA1c was associated with increased insulin pump use, especially in girls.In adult patients, sex differences in metabolic control and insulin pump use persist: women show constantly lower HbA1c values and higher insulin pump use.