1
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Lebbad H, Desir C, Vesin A, Adenis A, Charpentier G, Benhamou PY. Insulin Requirements According to Sex and Weight in a Population of 9036 Adult Persons With Type 1 Diabetes Using Closed-Loop Insulin Delivery. J Diabetes Sci Technol 2024:19322968241252366. [PMID: 38804537 DOI: 10.1177/19322968241252366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND The prediction of the individual insulin needs may facilitate the initiation of insulin therapy. Our aim was to explore the relationships between body weight, sex, and daily amounts of insulin delivered by a hybrid closed-loop system. METHODS We performed a retrospective data collection of all consenting adult patients with type 1 diabetes who were equipped in Europe with the Diabeloop Generation 1 (DBLG1) hybrid closed-loop insulin delivery device between March 1, 2021 and February 28, 2023. RESULTS A total of 9036 users (59% females, age 45.6 ± 14.3 years) were included, reaching a mean follow-up of 320 ± 143 days, an overall 2 887 188 days of data. We observed a mean insulin-weight ratio of 0.617 ± 0.207 U/kg (0.665 ± 0.217 for males and 0.584 ± 0.193 for females, P < .001). Exploratory analysis of a subset of 4066 patients reaching >70% Time in Range (70-180 mg/dL) showed a mean insulin-weight ratio of 0.55 ± 0.17 U/kg (P < .001) (0.59 ± 0.18 for the 1438 males and 0.53 ± 0.16 for the 2628 females). CONCLUSION This large real-world analysis provides a quantitative estimation of the daily insulin requirements in adult patients with type 1 diabetes and shows significant differences between sex. These findings have relevant implications in the practical management of insulin therapy.
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Affiliation(s)
| | | | | | | | - Guillaume Charpentier
- Center for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
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2
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Jafar A, Pasqua MR, Olson B, Haidar A. Advanced decision support system for individuals with diabetes on multiple daily injections therapy using reinforcement learning and nearest-neighbors: In-silico and clinical results. Artif Intell Med 2024; 148:102749. [PMID: 38325921 DOI: 10.1016/j.artmed.2023.102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
Many individuals with diabetes on multiple daily insulin injections therapy use carbohydrate ratios (CRs) and correction factors (CFs) to determine mealtime and correction insulin boluses. The CRs and CFs vary over time due to physiological changes in individuals' response to insulin. Errors in insulin dosing can lead to life-threatening abnormal glucose levels, increasing the risk of retinopathy, neuropathy, and nephropathy. Here, we present a novel learning algorithm that uses Q-learning to track optimal CRs and uses nearest-neighbors based Q-learning to track optimal CFs. The learning algorithm was compared with the run-to-run algorithm A and the run-to-run algorithm B, both proposed in the literature, over an 8-week period using a validated simulator with a realistic scenario created with suboptimal CRs and CFs values, carbohydrate counting errors, and random meals sizes at random ingestion times. From Week 1 to Week 8, the learning algorithm increased the percentage of time spent in target glucose range (4.0 to 10.0 mmol/L) from 51 % to 64 % compared to 61 % and 58 % with the run-to-run algorithm A and the run-to-run algorithm B, respectively. The learning algorithm decreased the percentage of time spent below 4.0 mmol/L from 9 % to 1.9 % compared to 3.4 % and 2.3 % with the run-to-run algorithm A and the run-to-run algorithm B, respectively. The algorithm was also assessed by comparing its recommendations with (i) the endocrinologist's recommendations on two type 1 diabetes individuals over a 16-week period and (ii) real-world individuals' therapy settings changes of 23 individuals (19 type 2 and 4 type 1) over an 8-week period using the commercial Bigfoot Unity Diabetes Management System. The full agreements (i) were 89 % and 76 % for CRs and CFs for the type 1 diabetes individuals and (ii) was 62 % for mealtime doses for the individuals on the commercial Bigfoot system. Therefore, the proposed algorithm has the potential to improve glucose control in individuals with type 1 and type 2 diabetes.
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Affiliation(s)
- Adnan Jafar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Melissa-Rosina Pasqua
- Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada; The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Byron Olson
- Bigfoot Biomedical Inc., Milpitas, CA, United States
| | - Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada; Division of Endocrinology, Department of Medicine, McGill University, Montreal, Quebec, Canada; The Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
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3
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Pihoker C, Shulman DI, Forlenza GP, Kaiserman KB, Sherr JL, Thrasher JR, Buckingham BA, Kipnes MS, Bode BW, Carlson AL, Lee SW, Latif K, Liljenquist DR, Slover RH, Dai Z, Niu F, Shin J, Jonkers RAM, Roy A, Grosman B, Vella M, Cordero TL, McVean J, Rhinehart AS, Vigersky RA. Safety and Glycemic Outcomes During the MiniMed TM Advanced Hybrid Closed-Loop System Pivotal Trial in Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:755-764. [PMID: 37782145 DOI: 10.1089/dia.2023.0255] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: During MiniMed™ advanced hybrid closed-loop (AHCL) use by adolescents and adults in the pivotal trial, glycated hemoglobin (A1C) was significantly reduced, time spent in range (TIR) was significantly increased, and there were no episodes of severe hypoglycemia or diabetic ketoacidosis (DKA). The present study investigated the same primary safety and effectiveness endpoints during AHCL use by a younger cohort with type 1 diabetes (T1D). Methods: An intention-to-treat population (N = 160, aged 7-17 years) with T1D was enrolled in a single-arm study at 13 investigational centers. There was a run-in period (∼25 days) using HCL or sensor-augmented pump with/without predictive low-glucose management, followed by a 3-month study period with AHCL activated at two glucose targets (GTs; 100 and 120 mg/dL) for ∼45 days each. The mean ± standard deviation values of A1C, TIR, mean sensor glucose (SG), coefficient of variation (CV) of SG, time at SG ranges, and insulin delivered between run-in and study were analyzed (Wilcoxon signed-rank test or t-test). Results: Compared with baseline, AHCL use was associated with reduced A1C from 7.9 ± 0.9% (N = 160) to 7.4 ± 0.7% (N = 136) (P < 0.001) and overall TIR increased from the run-in 59.4 ± 11.8% to 70.3 ± 6.5% by end of study (P < 0.001), without change in CV, time spent below range (TBR) <70 mg/dL, or TBR <54 mg/dL. Relative to longer active insulin time (AIT) settings (N = 52), an AIT of 2 h (N = 19) with the 100 mg/dL GT increased mean TIR to 73.4%, reduced TBR <70 mg/dL from 3.5% to 2.2%, and reduced time spent above range (TAR) >180 mg/dL from 28.7% to 24.4%. During AHCL use, there was no severe hypoglycemia or DKA. Conclusions: In children and adolescents with T1D, MiniMed AHCL system use was safe, A1C was lower, and TIR was increased. The lowest GT and shortest AIT were associated with the highest TIR and lowest TBR and TAR, all of which met consensus-recommended glycemic targets. ClinicalTrials.gov ID: NCT03959423.
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Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dorothy I Shulman
- University of South Florida, Pediatric Diabetes and Endocrinology, Tampa, Florida, USA
| | - Gregory P Forlenza
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | | | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James R Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | - Bruce A Buckingham
- Stanford University School of Medicine, Pediatric Diabetes and Endocrinology, Stanford, California, USA
| | - Mark S Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | - Bruce W Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Anders L Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Scott W Lee
- Department of Endocrinology, Loma Linda University, Loma Linda, California, USA
| | - Kashif Latif
- AM Diabetes and Endocrinology Center, Bartlett, Tennessee, USA
| | | | - Robert H Slover
- Department of Pediatrics, Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Zheng Dai
- Medtronic, Northridge, California, USA
| | - Fang Niu
- Medtronic, Northridge, California, USA
| | - John Shin
- Medtronic, Northridge, California, USA
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4
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Silva Júnior WS, Gabbay MAL, Lamounier RN, Calliari LE, Bertoluci MC. The 2021-2022 position of Brazilian Diabetes Society on insulin therapy in type 1 diabetes: an evidence-based guideline to clinical practice. Diabetol Metab Syndr 2022; 14:189. [PMID: 36510287 PMCID: PMC9743602 DOI: 10.1186/s13098-022-00949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Insulin therapy regimens for people with type 1 diabetes (PWT1D) should mimic the physiological insulin secretion that occurs in individuals without diabetes. Intensive insulin therapy, whether by multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII), constitutes the fundamental therapy from the initial stages of type 1 diabetes (T1D), at all ages. This review is an authorized literal translation of part of the Brazilian Diabetes Society (SBD) Guidelines 2021-2022. This evidence-based guideline supplies guidance on insulin therapy in T1D. METHODS The methods were published elsewhere in earlier SBD guidelines and was approved by the Internal Institutional Steering Committee for publication. Briefly, the Brazilian Diabetes Society indicated fourteen experts to constitute the Central Committee, designed to regulate the method review of the manuscripts, and judge the degrees of recommendations and levels of evidence. SBD Type 1 Diabetes Department drafted the manuscript selecting key clinical questions to do a narrative review using MEDLINE via PubMed, with the best evidence available, including high-quality clinical trials, metanalysis, and large observational studies related to insulin therapy in T1D, by using the Mesh terms [type 1 diabetes] and [insulin]. RESULTS Based on extensive literature review the Central Committee defined ten recommendations. Three levels of evidence were considered: A. Data from more than one randomised clinical trial (RCT) or one metanalysis of RCTs with low heterogeneity (I2 < 40%). B. Data from metanalysis, including large observational studies, a single RCT, or a pre-specified subgroup analysis. C: Data from small or non-randomised studies, exploratory analysis, or consensus of expert opinion. The degree of recommendation was obtained based on a poll sent to the panellists, using the following criteria: Grade I: when more than 90% of agreement; Grade IIa if 75-89% of agreement; IIb if 50-74% of agreement, and III, when most of the panellist recommends against a defined treatment. CONCLUSIONS In PWT1D, it is recommended to start insulin treatment immediately after clinical diagnosis, to prevent metabolic decompensation and diabetic ketoacidosis. Insulin therapy regimens should mimic insulin secretion with the aim to achieve glycemic control goals established for the age group. Intensive treatment with basal-bolus insulin therapy through MDI or CSII is recommended, and insulin analogues offers some advantages in PWT1D, when compared to human insulin. Periodic reassessment of insulin doses should be performed to avoid clinical inertia in treatment.
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Affiliation(s)
- Wellington S. Silva Júnior
- Brazilian Diabetes Society (Sociedade Brasileira de Diabetes—SBD), São Paulo, Brazil
- Endocrinology Discipline, Department of Medicine I, Faculty of Medicine, Center of Biological Sciences, Federal University of Maranhão (UFMA), Praça Gonçalves Dias, 21, Centro, São Luís, MA 65020-240 Brazil
| | - Monica Andrade Lima Gabbay
- Brazilian Diabetes Society (Sociedade Brasileira de Diabetes—SBD), São Paulo, Brazil
- Federal University of São Paulo (Unifesp), São Paulo, SP Brazil
| | - Rodrigo Nunes Lamounier
- Brazilian Diabetes Society (Sociedade Brasileira de Diabetes—SBD), São Paulo, Brazil
- Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Luis Eduardo Calliari
- Brazilian Diabetes Society (Sociedade Brasileira de Diabetes—SBD), São Paulo, Brazil
- Santa Casa School of Medical Sciences, São Paulo, SP Brazil
| | - Marcello Casaccia Bertoluci
- Brazilian Diabetes Society (Sociedade Brasileira de Diabetes—SBD), São Paulo, Brazil
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS Brazil
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5
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Sundberg F, deBeaufort C, Krogvold L, Patton S, Piloya T, Smart C, Van Name M, Weissberg-Benchell J, Silva J, diMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Managing diabetes in preschoolers. Pediatr Diabetes 2022; 23:1496-1511. [PMID: 36537520 PMCID: PMC10108244 DOI: 10.1111/pedi.13427] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Frida Sundberg
- The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Carine deBeaufort
- Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Department of Pediatric Endocrinology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Lars Krogvold
- Paediatric Department, Oslo University Hospital, Oslo, Norway
| | - Susana Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, Florida, USA
| | - Thereza Piloya
- Department of Paediatrics & Child Health, School of Medicine, College of Health Sciences Makerere University, Kampala, Uganda
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital and School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jose Silva
- SummitStone Health Partners, Fort Collins, Colorado, USA
| | - Linda A diMeglio
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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6
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Annan SF, Higgins LA, Jelleryd E, Hannon T, Rose S, Salis S, Baptista J, Chinchilla P, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1297-1321. [PMID: 36468223 DOI: 10.1111/pedi.13429] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- S Francesca Annan
- Paediatric Division, University College London Hospitals, London, UK
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Elisabeth Jelleryd
- Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Tamara Hannon
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Shelley Rose
- Diabetes & Endocrinology Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sheryl Salis
- Department of Nutrition, Nurture Health Solutions, Mumbai, India
| | | | - Paula Chinchilla
- Women's and Children's Department, London North West Healthcare NHS Trust, London, UK
| | - Maria Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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7
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Sherr JL, Schoelwer M, Dos Santos TJ, Reddy L, Biester T, Galderisi A, van Dyk JC, Hilliard ME, Berget C, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes 2022; 23:1406-1431. [PMID: 36468192 DOI: 10.1111/pedi.13421] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Melissa Schoelwer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Leenatha Reddy
- Department of Pediatrics Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Torben Biester
- AUF DER BULT, Hospital for Children and Adolescents, Hannover, Germany
| | - Alfonso Galderisi
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | | | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Cari Berget
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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8
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Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham S, Fairchild J, Jarosz-Chobot P, Ng SM, Paterson M, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1277-1296. [PMID: 36537533 DOI: 10.1111/pedi.13442] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eda Cengiz
- University of California San Francisco (UCSF) Pediatric Diabetes Program, UCSF School of Medicine, San Francisco, California, USA
| | - Thomas Danne
- Auf Der Bult, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Tariq Ahmad
- Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ahila Ayyavoo
- Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine University of Geneva and Geneva University Hospitals, Faculty of Medicine Diabetes Centre, Geneva, Switzerland
| | - Sarah Ehtisham
- Division of Pediatric Endocrinology, Mediclinic City Hospital, Dubai, UAE
| | - Jan Fairchild
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Megan Paterson
- John Hunter Children's Hospital, HRMC, New South Wales, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
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9
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Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Insulin pumps in children - a systematic review. World J Clin Pediatr 2022; 11:463-484. [PMID: 36439904 PMCID: PMC9685680 DOI: 10.5409/wjcp.v11.i6.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/02/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus, particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues. Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development. Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.
AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care, and its advantages and disadvantages.
METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022, related to pump therapy in children and published in the English language.
RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.
CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
- Department of Pediatrics, University Medical Center, Dr. Sulaiman Al Habib Medical Group, Manama, Bahrain, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Chest Disease, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, The Royal College of Surgeons in Ireland - Bahrain, Busiateen 15503, Muharraq, Bahrain
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10
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Development of a pharmacist-managed protocol for the transition from intravenous to subcutaneous insulin in critically ill adults. Am J Health Syst Pharm 2022; 79:S86-S93. [DOI: 10.1093/ajhp/zxac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Disclaimer
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose
To evaluate the efficacy and safety of a pharmacist-managed protocol for transitioning critically ill patients from intravenous (IV) to subcutaneous insulin.
Methods
This single-center, retrospective, observational study included patients admitted to the medical or surgical/trauma intensive care unit who received a continuous infusion of IV insulin from January 2019 to April 2021. Patients were excluded if they were less than 18 years old, pregnant, or incarcerated or received IV insulin for the diagnosis of diabetic ketoacidosis, hyperglycemic hyperosmolar state, calcium channel blocker or β-blocker overdose, or hypertriglyceridemia. The primary outcome was to evaluate the percentage of blood glucose (BG) concentrations within the target range of 70 to 150 mg/dL within 48 hours of the transition to subcutaneous insulin. Secondary outcomes included the percentage of BG concentrations within the goal range following transition at 0 to 12 hours and 12 to 24 hours, the incidence of hypo- and hyperglycemia, and the percentage of patients requiring dose adjustments after the initial transition.
Results
Pharmacists were able to achieve BG concentrations in the target range for 53% of transitions at 12 hours, 40% of transitions at 24 hours, and 47% of transitions at 48 hours. With respect to safety endpoints, the pharmacist-managed group had a low rate of hypoglycemia (1.0%) and no severe hypoglycemia. Hyperglycemia was reported for 28% of BG concentrations while severe hyperglycemia was reported for 27%. Pharmacists transitioned patients to an average of 63% of the 24-hour total daily dose of insulin as basal insulin.
Conclusion
Pharmacists can effectively and safely transition critically ill patients from IV to subcutaneous insulin utilizing a standardized protocol.
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11
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Hegab AM. Diurnal Variation of Real-Life Insulin Sensitivity Factor Among Children and Adolescents With Type 1 Diabetes Using Ultra-Long-Acting Basal Insulin Analogs. Front Pediatr 2022; 10:854972. [PMID: 35350271 PMCID: PMC8957904 DOI: 10.3389/fped.2022.854972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Estimation of insulin sensitivity factor (ISF) is essential for correction insulin doses calculation. This study aimed to assess real-life ISF among children and adolescents with type 1 diabetes using ultra-long-acting basal insulin analogs and to detect factors associated with ISF among those patients. METHODS This prospective observational study was conducted at Sohag University Hospital, Egypt, and included 93 participants aged 6-18 years, diagnosed with T1DM for at least 1 year and using insulin glargine 300 Units/mL or insulin degludec 100 Units/mL as basal insulin. The ISF, insulin-to-carbohydrate ratio (ICR) and insulin doses were initially assessed then adjusted as required. The participants were regularly contacted throughout the follow-up period. Glycemic control parameters were assessed after 3 months. RESULTS The ISF showed diurnal variation with higher correction dose requirements for the morning than for the rest of the day (p < 0.001). This pattern of diurnal variation was found in participants with different pubertal stages and in participants using either type of ultra-long acting basal insulin analogs. There was no significant difference between the ISF calculated according to the 1800 rule [1800/Total daily insulin dose (TDD)] and the morning ISF (p = 0.25). The 1800 rule-calculated ISF was significantly lower than the actual ISF for the afternoon (p < 0.001) and the evening (p < 0.001). ISF at different times of the day were significantly correlated with age, body mass index, pubertal stage, diabetes duration, TDD, and ICR. Multiple regression analysis revealed that ICR was the most significant factor associated with ISF. Linear regression analysis revealed that the ISF (in mg/dL) for any time of the day could be estimated as 5.14 × ICR for the same time of the day (coefficient = 5.14, 95% confidence interval: 5.10-5.19, R 2 = 0.95, p < 0.001). CONCLUSION Diurnal variation of ISF that had to be considered for proper calculation of correction doses. This diurnal variation was found in children and adolescents with different pubertal stages. The 1800 rule was appropriate for the morning correction doses but not in the afternoon or the evening. The TDD and the ICR could be used for ISF estimation.
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Affiliation(s)
- Ahmed M Hegab
- Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
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12
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63:2501-2520. [PMID: 33047169 DOI: 10.1007/s00125-020-05263-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. Graphical abstract.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria.
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Max L Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Sahlgrenska Academy at University of Gothenburg, Institution of Clinical Sciences, Gothenburg, Sweden
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada
- Endocrinology Division Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Montreal Diabetes Research Centre, Montréal, QC, Canada
| | | | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Nick S Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, London, UK
| | - Dessi P Zaharieva
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
- Department of Pediatrics, Free University Brussels (VUB), Brussels, Belgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Bahçeşehir Üniversitesi, Istanbul, Turkey
| | - Asma Deeb
- Paediatric Endocrinology Division, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFT, Derby, UK
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
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Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa‐Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Pediatr Diabetes 2020; 21:1375-1393. [PMID: 33047481 PMCID: PMC7702152 DOI: 10.1111/pedi.13105] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of BayreuthBayreuthGermany
| | - Michael C. Riddell
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Peter Adolfsson
- Department of PediatricsThe Hospital of HallandKungsbackaSweden
- Sahlgrenska Academy at University of GothenburgInstitution of Clinical SciencesGothenburgSweden
| | - Rémi Rabasa‐Lhoret
- Institut de recherches Cliniques de MontréalMontréalQCCanada
- Endocrinology division Centre Hospitalier Universitaire de MontréalMontréalQCCanada
- Nutrition Department, Faculty of MedicineUniversité de MontréalMontréalQCCanada
- Montreal Diabetes Research CentreMontréalQCCanada
| | | | - Pieter Gillard
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Kirsten Nørgaard
- Steno Diabetes Center CopenhagenUniversity of CopenhagenCopenhagenDenmark
| | - Nick S. Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial CollegeLondonLondonUK
| | - Dessi P. Zaharieva
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC ‐ University Children’s HospitalUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyCentre Hospitalier LuxembourgLuxembourgLuxembourg
- Department of Pediatrics, Free University Brussels (VUB)BrusselsBelgium
| | | | - Bruce Buckingham
- Department of Pediatric Endocrinology and DiabetesStanford University School of MedicineStanfordCaliforniaUSA
| | - Eda Cengiz
- Department of Pediatrics, Yale School of MedicineNew HavenConnecticutUSA
- Bahçeşehir Üniversitesi, IstanbulTurkey
| | - Asma Deeb
- Paediatric Endocrinology DivisionShaikh Shakhbout Medical CityAbu DhabiUnited Arab Emirates
| | | | - Simon Heller
- Department of Oncology & Metabolism, The Medical SchoolUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation Trust, SheffieldUK
| | | | - Lalantha Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Chantal Mathieu
- Department of EndocrinologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, InselspitalBern University Hospital and University of BernBernSwitzerland
| | - Martin Tauschmann
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Hood Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHSFTDerbyUK
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
| | - Carmel E. Smart
- School of Health Sciences, University of NewcastleCallaghanNew South WalesAustralia
- Department of Paediatric Diabetes and EndocrinologyJohn Hunter Children’s HospitalNewcastleNew South WalesAustralia
| | - Peter G. Jacobs
- Department of Biomedical EngineeringOregon Health & Science UniversityPortlandOregonUSA
| | - Richard M. Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazAustria
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Hegab AM. Prospective evaluation of insulin-to-carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy. Pediatr Diabetes 2019; 20:1087-1093. [PMID: 31433557 DOI: 10.1111/pedi.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/28/2019] [Accepted: 08/17/2019] [Indexed: 12/01/2022] Open
Abstract
AIM Assessment of insulin-to-carbohydrate ratio (ICR) in children and adolescents with type 1 diabetes mellitus (T1DM) using multiple daily injection (MDI) therapy. METHODS This prospective observational study was conducted over a 2-year period at Sohag University Hospital, Egypt. Children and adolescents aged 4 to 17 years, diagnosed with T1DM for at least 1 year, with fasting serum C-peptide levels <0.24 ng/dL and whose parents accepted to shift their management to flexible MDI using carbohydrate counting, were included. Participants were initially hospitalized for estimation of ICR and insulin doses, then followed-up monthly for further adjustments. Insulin doses, ICR, and glycemic control parameters were assessed after 3 months. RESULTS The study included 201 participants, 110 (54.7%) of them were males. The median age was 9.5 years (interquartile range: 7-12.5 years). Bolus insulin requirements estimated by the 500 rule were significantly lower than the actual doses used by the study participants for all meals (P < .001). Bolus insulin requirement for morning meal was significantly higher compared to other meals (P < .001). Linear regression analyses between ICR for different meals and the reciprocal of total daily dose (TDD) in 96 participants with optimum glycemic control revealed that ICR could be calculated as 301 to 309/TDD for morning meal (R2 = 0.97, P < .001), 317 to 331/TDD for afternoon meal (R2 = 0.96, P < .001), and 362 to 376/TDD for evening meal (R2 = 0.98, P < .001). CONCLUSIONS Bolus insulin requirements showed diurnal variation. Using 301 to 309/TDD, 317 to 331/TDD, and 362 to 376/TDD formulas would be more appropriate than the 500 rule for initial estimation of ICR for morning, afternoon, and evening meals, respectively.
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Affiliation(s)
- Ahmed M Hegab
- Pediatrics Department, Faculty of Medicine, Sohag University, Egypt
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15
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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16
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Sherr JL, Tauschmann M, Battelino T, de Bock M, Forlenza G, Roman R, Hood KK, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies. Pediatr Diabetes 2018; 19 Suppl 27:302-325. [PMID: 30039513 DOI: 10.1111/pedi.12731] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Tadej Battelino
- UMC-University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Gregory Forlenza
- University of Colorado Denver, Barbara Davis Center, Aurora, Colorado
| | - Rossana Roman
- Medical Sciences Department, University of Antofagasta and Antofagasta Regional Hospital, Antofagasta, Chile
| | - Korey K Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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17
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van Meijel LA, van den Heuvel-Bens SP, Zimmerman LJ, Bazelmans E, Tack CJ, de Galan BE. Effect of Automated Bolus Calculation on Glucose Variability and Quality of Life in Patients With Type 1 Diabetes on CSII Treatment. Clin Ther 2018; 40:862-871. [DOI: 10.1016/j.clinthera.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 02/01/2023]
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18
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Affiliation(s)
- David Rodbard
- Biomedical Informatics Consultants LLC , Potomac, Maryland
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19
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Tascini G, Berioli MG, Cerquiglini L, Santi E, Mancini G, Rogari F, Toni G, Esposito S. Carbohydrate Counting in Children and Adolescents with Type 1 Diabetes. Nutrients 2018; 10:E109. [PMID: 29361766 PMCID: PMC5793337 DOI: 10.3390/nu10010109] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CC) is a meal-planning tool for patients with type 1 diabetes (T1D) treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion. It is based on an awareness of foods that contain carbohydrates and their effect on blood glucose. The bolus insulin dose needed is obtained from the total amount of carbohydrates consumed at each meal and the insulin-to-carbohydrate ratio. Evidence suggests that CC may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c). Moreover, CC might reduce the frequency of hypoglycaemia. In addition, with CC the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own lifestyles. CC and the bolus calculator can have possible beneficial effects in improving post-meal glucose, with a higher percentage of values within the target. Moreover, CC might be integrated with the counting of fat and protein to more accurately calculate the insulin bolus. In conclusion, in children and adolescents with T1D, CC may have a positive effect on metabolic control, might reduce hypoglycaemia events, improves quality of life, and seems to do so without influencing body mass index; however, more high-quality clinical trials are needed to confirm this positive impact.
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Affiliation(s)
- Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Laura Cerquiglini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giulia Mancini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Francesco Rogari
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giada Toni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
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20
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Sundberg F, Barnard K, Cato A, de Beaufort C, DiMeglio LA, Dooley G, Hershey T, Hitchcock J, Jain V, Weissberg-Benchell J, Rami-Merhar B, Smart CE, Hanas R. ISPAD Guidelines. Managing diabetes in preschool children. Pediatr Diabetes 2017; 18:499-517. [PMID: 28726299 DOI: 10.1111/pedi.12554] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/14/2017] [Accepted: 05/31/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Frida Sundberg
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katharine Barnard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Allison Cato
- Neurology Division, Nemours Children's Health System, Jacksonville, Florida
| | - Carine de Beaufort
- Clinique Pediatrique, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg.,Department of Pediatrics, UZ Brussels, Jette, Belgium
| | - Linda A DiMeglio
- Department of Pediatrics, Section of Pediatric Endocrinology/Diabetology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Tamara Hershey
- Psychiatry Department, Washington University School of Medicine, St. Louis, Missouri.,Radiology Department, Washington University School of Medicine, St. Louis, Missouri
| | | | - Vandana Jain
- Pediatric Endocrinology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Carmel E Smart
- Department of Endocrinology, John Hunter Children's Hospital and University of Newcastle, Newcastle, Australia
| | - Ragnar Hanas
- Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
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