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Mellor J, Jeyam A, Beulens JW, Bhandari S, Broadhead G, Chew E, Fickweiler W, van der Heijden A, Gordin D, Simó R, Snell-Bergeon J, Tynjälä A, Colhoun H. Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment. OPHTHALMOLOGY SCIENCE 2024; 4:100494. [PMID: 38694495 PMCID: PMC11061755 DOI: 10.1016/j.xops.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 05/04/2024]
Abstract
Topic To review clinical evidence on systemic factors that might be relevant to update diabetic retinal disease (DRD) staging systems, including prediction of DRD onset, progression, and response to treatment. Clinical relevance Systemic factors may improve new staging systems for DRD to better assess risk of disease worsening and predict response to therapy. Methods The Systemic Health Working Group of the Mary Tyler Moore Vision Initiative reviewed systemic factors individually and in multivariate models for prediction of DRD onset or progression (i.e., prognosis) or response to treatments (prediction). Results There was consistent evidence for associations of longer diabetes duration, higher glycosylated hemoglobin (HbA1c), and male sex with DRD onset and progression. There is strong trial evidence for the effect of reducing HbA1c and reducing DRD progression. There is strong evidence that higher blood pressure (BP) is a risk factor for DRD incidence and for progression. Pregnancy has been consistently reported to be associated with worsening of DRD but recent studies reflecting modern care standards are lacking. In studies examining multivariate prognostic models of DRD onset, HbA1c and diabetes duration were consistently retained as significant predictors of DRD onset. There was evidence of associations of BP and sex with DRD onset. In multivariate prognostic models examining DRD progression, retinal measures were consistently found to be a significant predictor of DRD with little evidence of any useful marginal increment in prognostic information with the inclusion of systemic risk factor data apart from retinal image data in multivariate models. For predicting the impact of treatment, although there are small studies that quantify prognostic information based on imaging data alone or systemic factors alone, there are currently no large studies that quantify marginal prognostic information within a multivariate model, including both imaging and systemic factors. Conclusion With standard imaging techniques and ways of processing images rapidly evolving, an international network of centers is needed to routinely capture systemic health factors simultaneously to retinal images so that gains in prediction increment may be precisely quantified to determine the usefulness of various health factors in the prognosis of DRD and prediction of response to treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joe Mellor
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Anita Jeyam
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Geoffrey Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ward Fickweiler
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Amber van der Heijden
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Rafael Simó
- Endocrinology & Nutrition, Institut de Recerca Hospital Universitari Vall d’Hebron (VHIR), Barcelona, Spain
| | - Janet Snell-Bergeon
- Clinical Epidemiology Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Colorado
| | - Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Helen Colhoun
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
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Liu TYA, Shpigel J, Khan F, Smith K, Prichett L, Channa R, Kanbour S, Jones M, Abusamaan MS, Sidhaye A, Mathioudakis N, Wolf RM. Use of Diabetes Technologies and Retinopathy in Adults With Type 1 Diabetes. JAMA Netw Open 2024; 7:e240728. [PMID: 38446483 PMCID: PMC10918500 DOI: 10.1001/jamanetworkopen.2024.0728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
Importance Diabetic retinopathy (DR) is a complication of diabetes that can lead to vision loss. Outcomes of continuous glucose monitoring (CGM) and insulin pump use in DR are not well understood. Objective To assess the use of CGM, insulin pump, or both, and DR and proliferative diabetic retinopathy (PDR) in adults with type 1 diabetes (T1D). Design, Setting, and Participants A retrospective cohort study of adults with T1D in a tertiary diabetes center and ophthalmology center was conducted from 2013 to 2021, with data analysis performed from June 2022 to April 2023. Exposure Use of diabetes technologies, including insulin pump, CGM, and both CGM and insulin pump. Main Outcomes and Measures The primary outcome was development of DR or PDR. A secondary outcome was the progression of DR for patients in the longitudinal cohort. Multivariable logistic regression models assessed for development of DR and PDR and association with CGM and insulin pump use. Results A total of 550 adults with T1D were included (median age, 40 [IQR, 28-54] years; 54.4% female; 24.5% Black or African American; and 68.4% White), with a median duration of diabetes of 20 (IQR, 10-30) years, and median hemoglobin A1c (HbA1c) of 7.8% (IQR, 7.0%-8.9%). Overall, 62.7% patients used CGM, 58.2% used an insulin pump, and 47.5% used both; 44% (244 of 550) of the participants had DR at any point during the study. On univariate analysis, CGM use was associated with lower odds of DR and PDR, and CGM with pump was associated with lower odds of PDR (all P < .05), compared with no CGM use. Multivariable logistic regression adjusting for age, sex, race and ethnicity, diabetes duration, microvascular and macrovascular complications, insurance type, and mean HbA1c, showed that CGM was associated with lower odds of DR (odds ratio [OR], 0.52; 95% CI, 0.32-0.84; P = .008) and PDR (OR, 0.42; 95% CI, 0.23-0.75; P = .004), compared with no CGM use. In the longitudinal analysis of participants without baseline PDR, 79 of 363 patients (21.8%) had progression of DR during the study. Conclusions and Relevance In this cohort study of adults with T1D, CGM use was associated with lower odds of developing DR and PDR, even after adjusting for HbA1c. These findings suggest that CGM may be useful for diabetes management to mitigate risk for DR and PDR.
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Affiliation(s)
- T. Y. Alvin Liu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Shpigel
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fatima Khan
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kerry Smith
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Prichett
- Epidemiology and Data Management (BEAD) Core, Johns Hopkins School of Medicine Biostatistics, Baltimore, Maryland
| | - Roomasa Channa
- Department of Ophthalmology, University of Wisconsin, Madison
| | - Sarah Kanbour
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marissa Jones
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohammed S. Abusamaan
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aniket Sidhaye
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Risa M. Wolf
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Pauley ME, Tommerdahl KL, Snell-Bergeon JK, Forlenza GP. Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits. Curr Cardiol Rep 2022; 24:2043-2056. [PMID: 36279036 PMCID: PMC9589770 DOI: 10.1007/s11886-022-01799-x] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The incidence of type 1 diabetes (T1D) is rising in all age groups. T1D is associated with chronic microvascular and macrovascular complications but improving glycemic trends can delay the onset and slow the progression of these complications. Utilization of technological devices for diabetes management, such as continuous glucose monitors (CGM) and insulin pumps, is increasing, and these devices are associated with improvements in glycemic trends. Thus, device use may be associated with long-term prevention of T1D complications, yet few studies have investigated the direct impacts of devices on chronic complications in T1D. This review will describe common diabetes devices and combination systems, as well as review relationships between device use and cardiovascular outcomes in T1D. RECENT FINDINGS Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality. CVD is the leading cause of morbidity and mortality in T1D. Consistent use of diabetes devices may protect against the development and progression of macrovascular complications such as CVD through improvement in glycemic trends. Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D.
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Affiliation(s)
- Meghan E Pauley
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
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Piona C, Ventrici C, Marcovecchio L, Chiarelli F, Maffeis C, Bonfanti R, Rabbone I. Long-term complications of type 1 diabetes: what do we know and what do we need to understand? Minerva Pediatr (Torino) 2021; 73:504-522. [PMID: 34530587 DOI: 10.23736/s2724-5276.21.06545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term complications of type 1 diabetes (T1D) include microvascular complications and macrovascular disease. Despite the important advances in the treatment of T1D of the last decades, these complications still represent the leading cause of morbidity and mortality in patients with T1D. Extensive evidence indicates that structural and functional alterations of the kidney, retina, nerves and large arteries occur already in the first years after the onset of diabetes. We performed a comprehensive review of the available evidence on screening, diagnosis, prevention and treatment of vascular complications of T1D. In particular, we focused on three major challenges related to long-term complications of T1D: 1) finding of new biomarkers and diagnostic methods able to identify early signs of complications; 2) identifying specific risk factors for the development of these complications; 3) identifying and implementing new therapeutic strategies able to prevent the development and progression of vascular complications.
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Affiliation(s)
- Claudia Piona
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Claudia Ventrici
- Paediatric Unit, Hospital of Polistena, Polistena, Reggio Calabria, Italy
| | | | | | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy -
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Reid LJ, Gibb FW, Colhoun H, Wild SH, Strachan MWJ, Madill K, Dhillon B, Forbes S. Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin. Diabetologia 2021; 64:1725-1736. [PMID: 33966091 PMCID: PMC8245368 DOI: 10.1007/s00125-021-05456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/01/2021] [Indexed: 01/03/2023]
Abstract
AIMS/HYPOTHESIS We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI). METHODS This is a retrospective cohort study using the Scottish Care Information - Diabetes database for retinal screening outcomes and HbA1c changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan-Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA1c, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA1c and change in HbA1c on diabetic retinopathy progression was assessed within CSII and MDI cohorts. RESULTS CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA1c and higher diastolic BP at baseline. There was a larger reduction in HbA1c at 1 year in those on CSII vs MDI (-6 mmol/mol [-0.6%] vs -2 mmol/mol [-0.2%], p < 0.01). Diabetic retinopathy progression occurred in a smaller proportion of adults following commencement of CSII vs continued MDI therapy over mean 2.3 year follow-up (26.5% vs 18.6%, p = 0.0097). High baseline HbA1c (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA1c at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. CONCLUSIONS/INTERPRETATION CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA1c. Progression of diabetic retinopathy over 3 years was not associated with a change in HbA1c.
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Affiliation(s)
- Laura J Reid
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
| | - Helen Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
| | - Karen Madill
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
- Centre for Clinical Brain Sciences, School of Clinical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Shareen Forbes
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK.
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Kramer G, Kloos C, Müller UA, Wolf G, Kuniss N. Metabolic control and hypoglycaemia in people with type 1 diabetes: insulin pump therapy vs. intensified insulin therapy in an unselected cohort in routine care. Diabetol Metab Syndr 2021; 13:80. [PMID: 34301317 PMCID: PMC8305953 DOI: 10.1186/s13098-021-00700-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS The aim of this study was to compare individuals with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and intensified insulin therapy (ICT) in routine care regarding metabolic control and treatment satisfaction. METHODS Individuals with type 1 diabetes (CSII n = 74; ICT n = 163) were analysed regarding metabolic control, frequency of hypoglycaemia and treatment satisfaction (DTSQs range 0-36). RESULTS Individuals with CSII (duration of CSII: 14.1 ± 7.2 years) were younger (51.1 ± 15.8 vs. 56.2 ± 16.2 years, p = 0.023), had longer diabetes duration (28.7 ± 12.4 vs. 24.6 ± 14.3 years, p = 0.033), lower insulin dosage (0.6 ± 0.2 vs. 0.7 ± 0.4 IU/kg, p = 0.004), used more frequently short-acting analogue insulin (90.5% vs. 48.5%, p < 0.001) and flash/continuous glucose monitoring (50.0% vs. 31.9%, p = 0.009) than people with ICT. HbA1c was similar between CSII and ICT (7.1 ± 0.8%/54.4 ± 9.1 mmol/mol vs. 7.2 ± 1.0%/55.7 ± 10.9 mmol/mol, p = 0.353). Individuals with CSII had higher frequency of non-severe hypoglycaemia per week (in people with blood glucose monitoring: 1.9 ± 1.7 vs. 1.2 ± 1.6, p = 0.014; in people with flash/continuous glucose monitoring: 3.3 ± 2.2 vs. 2.1 ± 2.0, p = 0.006). Prevalence of polyneuropathy (18.9% vs. 38.0%, p = 0.004) and systolic blood pressure (138.0 ± 16.4 vs. 143.9 ± 17.1 mmHg, p = 0.014) was lower in CSII. Satisfaction with diabetes treatment (26.7 ± 7.3 vs. 26.0 ± 6.8, p = 0.600) did not differ between CSII and ICT. CONCLUSIONS CSII and ICT yielded comparable metabolic control and treatment satisfaction but CSII was associated with higher incidence of non-severe hypoglycaemia and lower insulin dosage.
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Affiliation(s)
- Guido Kramer
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Ulrich A Müller
- Outpatient healthcare centre Dr. med. Kielstein, Erfurt, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Nadine Kuniss
- Department of Internal Medicine III, Endocrinology and Metabolic Disorders, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Outpatient healthcare centre Dr. med. Kielstein, Erfurt, Germany.
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Renard E. Personal Experience With COVID-19 and Diabetes in the South of France: Technology Facilitates the Management of Diabetes in Disruptive Times. J Diabetes Sci Technol 2020; 14:772-773. [PMID: 32429701 PMCID: PMC7673169 DOI: 10.1177/1932296820929370] [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] [Indexed: 12/19/2022]
Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, France
- Institute of Functional Genomics, CNRS UMR 5203, INSERM U1191, University of Montpellier, France
- INSERM Clinical Investigation Centre 1411, Montpellier, France
- Eric Renard, MD, PhD, Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Lapeyronie Hospital, Avenue Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
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Gajewska KA, Bennett K, Biesma R, Sreenan S. Low uptake of continuous subcutaneous insulin infusion therapy in people with type 1 diabetes in Ireland: a retrospective cross-sectional study. BMC Endocr Disord 2020; 20:92. [PMID: 32576284 PMCID: PMC7310521 DOI: 10.1186/s12902-020-00573-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The uptake of continuous subcutaneous insulin infusion (CSII) therapy in those with type 1 diabetes varies internationally and is mainly determined by the national healthcare reimbursement systems. The aim of this study is to estimate national and regional uptake of CSII therapy in children, adolescents and adults with type 1 diabetes in Ireland. METHODS A retrospective cross-sectional study was conducted utilizing the national pharmacy claims database in 2016. Individuals using CSII were identified by dispensing of infusion sets. The uptake of CSII was calculated as the percentage of people with type 1 diabetes claiming CSII sets in 2016, both in children and adolescent (age < 18 years) and adult populations (≥ 18 years). Descriptive statistics including percentages with 95% confidence intervals (CIs) are presented, stratified by age-groups and geographical regions, and chi-square tests used for comparisons. RESULTS Of 20,081 people with type 1 diabetes, 2111 (10.5, 95% CI: 10.1-10.9%) were using CSII in 2016. Uptake was five-fold higher in children and adolescents at 34.7% (95% CI: 32.9-36.5%) than in adults at 6.8% (95% CI: 6.4-7.2%). Significant geographical heterogeneity in CSII uptake was found, from 12.6 to 53.7% in children and adolescents (p < 0.001), and 2 to 9.6% in adults (p < 0.001). CONCLUSIONS Uptake of CSII in people with type 1 diabetes is low in Ireland, particularly in those ≥18 years. Identification of barriers to uptake, particularly in this group, is required.
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Affiliation(s)
- Katarzyna Anna Gajewska
- Division of Population Health Scineces, RCSI: University of Medicine and Health Sciences, Dublin, Ireland.
| | - Kathleen Bennett
- Division of Population Health Scineces, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
| | - Regien Biesma
- Department of Health Sciences, Global Health, Univeristy Medical Centre Groningen, Groningen, the Netherlands
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Scineces, Dublin, Ireland
- Diabetes and Endocrinology. RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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Bulc M, Całka J, Palus K. Effect of Streptozotocin-Inducted Diabetes on the Pathophysiology of Enteric Neurons in the Small Intestine Based on the Porcine Diabetes Model. Int J Mol Sci 2020; 21:E2047. [PMID: 32192078 PMCID: PMC7139978 DOI: 10.3390/ijms21062047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/31/2022] Open
Abstract
Hyperglycemia is one of the main causes of diabetes complications. Gastrointestinal (GI) disturbances are one of the most frequent complications during diabetes. The porcine digestive tract possesses physiological and pathological similarities to the human digestive tract. This also applies to the innervation of the gastrointestinal tract. In this study, the influence of experimentally-inducted hyperglycemia was examined on the expression of vesicular acetylcholine transporter (VAChT), cocaine- and amphetamine-regulated transcript (CART), galanin (GAL), vasoactive intestinal polypeptide (VIP), and calcitonin gene-related peptide (CGRP) in the enteric nervous system (ENS) neurons in the small intestine of the pig. During the current study, an increased number of neurons containing CART, VIP, GAL, and CGRP under streptozotocin injection were observed. The augmentation of expression included all enteric plexuses present in the small intestine. The same results were obtained in the case of VAChT; namely, chronic hyperglycemia led to an increase in the number of neurons utilizing VAChT in all investigated plexuses. The obtained results suggested that the function of neuropeptides studied in this experiment depended on their localization in the ENS structures, as well as part of the GI tract. Diabetes led to alterations in the neurochemical phenotype of small intestine enteric neurons.
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Affiliation(s)
- Michał Bulc
- Department of Clinical Physiology Faculty of Veterinary Medicine, University of Warmia and Mazury, Oczapowskiego Str. 13, 10-719 Olsztyn, Poland; (J.C.); (K.P.)
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10
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Derosa G, Catena G, Scelsi L, D'Angelo A, Raddino R, Cosentino E, Maggi A, Pasini G, Borghi C, Maffioli P. Glyco-metabolic control, inflammation markers, and cardiovascular outcomes in type 1 and type 2 diabetic patients on insulin pump or multiple daily injection (italico study). Diabetes Metab Res Rev 2020; 36:e3219. [PMID: 31642581 DOI: 10.1002/dmrr.3219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/19/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate if the positive effects recorded on glycaemic control with continuous subcutaneous insulin infusion (CSII) were maintained on the long-term compared with multiple daily injection (MDI). The secondary objective was to evaluate if there is a reduction of type and number of cardiovascular events (CV). METHODS This retrospective, observational study evaluated glycaemic control and the number of CV in 104 patients with type 1 or 2 diabetes previously treated with MDI and initiating CSII therapy with tubed insulin pumps compared with 109 patients previously treated with MDI continuing MDI. RESULTS After 8 years, the glycaemic control including glycated haemoglobin (HbA1c ), fasting plasma glucose (FPG), and prandial plasma glucose (PPG) improved with both CSII and MDI compared with baseline; however, HbA1c , FPG, and PPG recorded with CSII were lower than data recorded with MDI. During the 8 years, there were fewer CV events with CSII, compared with MDI, and in particular, there were fewer cases of atrial fibrillation, premature ventricular contractions, acute coronary infarction, angina pectoris, heart failure, and peripheral vascular ischemia. We did not record any reduction of ischemic stroke events. CONCLUSION Our preliminary data suggest that CSII treatment seems to reduce the rates of CV compared with MDI therapy. Moreover, CSII also improved glycaemic control, without increasing the number of hypoglycaemia. However, given the observational design of this trial, our data should be validated in a randomized clinical trial; if they will be confirmed, CSII could be chosen for fully informed and motivated patients at higher risk of developing CV.
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Affiliation(s)
- Giuseppe Derosa
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Laura Scelsi
- Cardiology Division, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angela D'Angelo
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Eugenio Cosentino
- Medical and Surgery Sciences Department, University of Bologna, Bologna, Italy
| | - Antonio Maggi
- Cardiologic Unit, Poliambulanza Foundation, Brescia, Italy
| | - Gianfranco Pasini
- Cardiologic Unit, Presidio Ospedaliero di Gavardo, Gavardo, Brescia, Italy
| | - Claudio Borghi
- Medical and Surgery Sciences Department, University of Bologna, Bologna, Italy
| | - Pamela Maffioli
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Sora ND, Shashpal F, Bond EA, Jenkins AJ. Insulin Pumps: Review of Technological Advancement in Diabetes Management. Am J Med Sci 2019; 358:326-331. [DOI: 10.1016/j.amjms.2019.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
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Viñals C, Quirós C, Giménez M, Conget I. Real-Life Management and Effectiveness of Insulin Pump with or Without Continuous Glucose Monitoring in Adults with Type 1 Diabetes. Diabetes Ther 2019; 10:929-936. [PMID: 30900146 PMCID: PMC6531534 DOI: 10.1007/s13300-019-0599-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To describe and compare the routine use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) patients with and without continuous glucose monitoring (CGM) in routine clinical practice and its relationship with glycemic outcomes. METHODS Retrospective observational case-control study collecting routine use of CSII and CGM in T1D patients between January 2016 and December 2016. Patients with T1D using sensor augmented pump (SAP) were matched by sex and disease duration in a 1:3 ratio with those treated only with CSII. Patients used a Paradigm Veo or 640G Medtronic-Minimed® insulin pump with or without a glucose sensor (Enlite, Medtronic-Minimed®) for at least 12 months. RESULTS A total of 160 subjects with T1D were included, 40 using SAP and 120 on CSII (age 47 ± 12 years, 88 women, diabetes duration 29 ± 9.0 years, 10 ± 4.7 years on CSII, HbA1C 7.6 ± 0.8%). Those in SAP therapy used the sensor 63% of time, performed less self-monitored blood glucose (SMBG)/day (3.3 ± 1.9 vs. 4.5 ± 2.0; p < 0.01), more bolus/day (6.2 ± 3.6 vs. 4.8 ± 1.6; p < 0.05), more basal insulin segment/day (6.5 ± 2.1 vs. 5.9 ± 1.5; p < 0.05), and more suspension time of the pump (97 ± 93 vs. 9.6 ± 20 min/day; p < 0.0001). Regarding metabolic control, SAP therapy patients had lower HbA1c (7.4 ± 0.7 vs. 7.7 ± 0.9%; p = 0.068), lower average SMBG value (151 ± 32 vs. 163 ± 30 mg/dL; p < 0.05), a lower percentage of SMBG values greater than 180 mg/dL (30 ± 19 vs. 37 ± 16%; p < 0.05) with no differences in SMBG values less than 70 mg/dL (12 ± 8.0 vs. 9.8 ± 9.8%; p = 0.33) compared with patients on CSII. There were no differences in bolus wizard targets or in insulin/carbohydrate ratios per day. CONCLUSION In a real-world setting, SAP therapy is associated with more self-adjustments of insulin therapy when compared to CSII alone. This could result in an improvement in glucose control.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Carmen Quirós
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Tarrasa, Tarrasa, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.
- CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Barcelona, Spain.
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Sumnik Z, Szypowska A, Iotova V, Bratina N, Cherubini V, Forsander G, Jali S, Raposo JF, Stipančic G, Vazeou A, Veeze H, Lange K. Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective. Pediatr Diabetes 2019; 20:434-443. [PMID: 30773756 DOI: 10.1111/pedi.12833] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/25/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frequent use of modern diabetes technologies increases the chance for optimal type 1 diabetes (T1D) control. Limited reimbursement influences the access of patients with T1D to these modalities and could worsen their prognosis. We aimed to describe the situation of reimbursement for insulins, glucometers, insulin pumps (CSII) and continuous glucose monitoring (CGM) for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with data from our previous study in 2009. METHODS The study was conducted between March 2017 and August 2017. First, we approached diabetes technology companies with a survey to map the reimbursement of insulins and diabetic devices. The data collected from these companies were then validated by members of the SWEET consortium. RESULTS We collected data from 29 European countries, whereas all types of insulins are mostly fully covered, heterogeneity was observed regarding the reimbursement of strips for glucometers (from 90 strips/month to no limit). CSII is readily available in 20 of 29 countries. Seven countries reported significant quota issues or obstacles for CSII prescription, and two countries had no CSII reimbursement. CGM is at least partially reimbursed in 17 of 29 countries. The comparison with the 2009 study showed an increasing availability of CSII and CGM across the EU. CONCLUSIONS Although innovative diabetes technology is available, a large proportion of children with T1D still do not benefit from it due to its limited reimbursement.
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Affiliation(s)
- Zdenek Sumnik
- Department of Pediatrics, Motol University Hospital, Prague, Czech Republic
| | | | - Violeta Iotova
- Department of Pediatrics, Medical University-Varna, UMHAT "Sv. Marina", Varna, Bulgaria
| | - Natasa Bratina
- Department of Endocrinology, Diabetes and Metabolism, UMC, University Children's Hospital, Ljubljana, Slovenia
| | - Valentino Cherubini
- Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, "G. Salesi" Hospital, Ancona, Italy
| | - Gun Forsander
- Institute for Clinical Sciences, Dept of Ped, University of Gothenburg and the Queen Silvia Children's Hospital, Sahlgrenska Univ. Hospital, Gothenburg, Sweden
| | - Sujata Jali
- Department of Pediatrics, KLE University's Jawaharlal Nehru Medical College Belgaum, Belgaum, India
| | | | - Gordana Stipančic
- Department of Pediatrics, University Hospital Center "Sestre milosrdnice", School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Andriani Vazeou
- Department of Pediatrics, Diabetes Center, P & A Kyriakou Children's Hospital, Athens, Greece
| | | | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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