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Andreopoulou O, Kostopoulou E, Kotanidou E, Daskalaki S, Vakka A, Galli-Tsinopoulou A, Spiliotis BE. Evaluation of the possible impact of the fear of hypoglycemia on diabetes management in children and adolescents with type 1 diabetes mellitus and their parents: a cross-sectional study. Hormones (Athens) 2024:10.1007/s42000-024-00560-z. [PMID: 38607611 DOI: 10.1007/s42000-024-00560-z] [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] [Received: 10/07/2023] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Hypoglycemia represents a significant source of anxiety for children with type 1 diabetes mellitus (T1DM) and their caretakers. Fear of hypoglycemia (FoH) was measured in children and adolescents with T1DM as well as in their parents using an established research instrument, the Hypoglycemia Fear Survey (HFS). METHODS This is a two-center, cross-sectional study involving 100 children and adolescents aged 6-18 years old diagnosed with T1DM. One parent of each child also participated in the study. The participants, who were recruited from two different pediatric endocrine outpatient clinics, were asked to complete the translated Greek version of the HFS, which includes one version for children (C-HFS) and one for parents (P-HFS). The association of the questionnaire responses with subjects' characteristics, such as current age, age at diagnosis, duration of diabetes, HbA1c levels, and mode of diabetes treatment were assessed. RESULTS Parents exhibited significantly higher mean HFS scores than their children. No significant correlation was found between the P-HFS or the C-HFS scores and the age of the children, duration of diabetes, HbA1c, or mode of treatment. CONCLUSION The finding that parents experience higher levels of FoH compared to their children emphasizes the importance of healthcare providers to screen parental FoH and focus on approaches to support them in order to reduce their psychological burden, thus optimizing children's diabetes management.
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Affiliation(s)
- Ourania Andreopoulou
- Department of Psychiatry, University of Patras Medical School, Rio, 26500, Greece.
| | - Eirini Kostopoulou
- Department of Psychiatry, University of Patras Medical School, Rio, 26500, Greece
| | - Eleni Kotanidou
- Unit of Pediatric and Adolescent Diabetes Mellitus, Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Sophia Daskalaki
- Department of Electrical and Computer Engineering, School of Engineering, University of Patras, Patras, 26500, Greece
| | - Angeliki Vakka
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, Patras, 26500, Greece
| | - Assimina Galli-Tsinopoulou
- Unit of Pediatric and Adolescent Diabetes Mellitus, Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Bessie E Spiliotis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, Patras, 26500, Greece
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Åm MK, Teigen IA, Riaz M, Fougner AL, Christiansen SC, Carlsen SM. The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control. J Endocrinol Invest 2024; 47:513-521. [PMID: 37715091 PMCID: PMC10904408 DOI: 10.1007/s40618-023-02193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Diabetes mellitus type 1 is a chronic disease that implies mandatory external insulin delivery. The patients must monitor their blood glucose levels and administer appropriate insulin boluses to keep their blood glucose within the desired range. It requires a lot of time and endeavour, and many patients struggle with suboptimal glucose control despite all their efforts. MATERIALS AND METHODS This narrative review combines existing knowledge with new discoveries from animal experiments. DISCUSSION In the last decade, artificial pancreas (AP) devices have been developed to improve glucose control and relieve patients of the constant burden of managing their disease. However, a feasible and fully automated AP is yet to be developed. The main challenges preventing the development of a true, subcutaneous (SC) AP system are the slow dynamics of SC glucose sensing and particularly the delay in effect on glucose levels after SC insulin infusions. We have previously published studies on using the intraperitoneal space for an AP; however, we further propose a novel and potentially disruptive way to utilize the vasodilative properties of glucagon in SC AP systems. CONCLUSION This narrative review presents two lesser-explored viable solutions for AP systems and discusses the potential for improvement toward a fully automated system: A) using the intraperitoneal approach for more rapid insulin absorption, and B) besides using glucagon to treat and prevent hypoglycemia, also administering micro-boluses of glucagon to increase the local SC blood flow, thereby accelerating SC insulin absorption and SC glucose sensor site dynamics.
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Affiliation(s)
- M K Åm
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway.
| | - I A Teigen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M Riaz
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A L Fougner
- Department of Engineering Cybernetics, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - S C Christiansen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - S M Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8900, 7491, Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Monzon AD, Majidi S, Clements MA, Patton SR. The Relationship Between Parent Fear of Hypoglycemia and Youth Glycemic Control Across the Recent-Onset Period in Families of Youth with Type 1 Diabetes. Int J Behav Med 2024; 31:64-74. [PMID: 36745325 DOI: 10.1007/s12529-023-10159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aims to examine the relationship between parents' fear of hypoglycemia (FH) over a 1-year period and child glucose metrics in 126 families of youth recently diagnosed with type 1 diabetes (T1D). METHODS Parents completed the Hypoglycemia Fear Survey for Parents (HFS-P) and uploaded 14 days of glucose data at a baseline, 6-month, and 12-month assessment. RESULTS Parents' HFS-P total and worry scores increased to a clinically meaningful degree from baseline to 6-month assessment, while multilevel models revealed within- and between-person variability in parents' HFS-P worry and behavior scores over time associated with child glycemia. Specifically, a significant negative relationship for within-person worry scores suggested that when parents reported higher than their average worry scores, their children recorded fewer glucose values in the target range, while within-person behavior scores suggested that when parents reported lower than their average behavior scores, their children recorded more values above the target range. There was also a negative relationship for between-person behavior scores with child glycated hemoglobin and a positive relationship for between-person behavior scores with child glucose values in the target range. CONCLUSIONS In the recent-onset period of T1D, parental FH worry and behavior associated with child glycemia possibly due to changes in parents' perceptions of their child's hypoglycemia risk. The clinically meaningful increases in parent FH in the recent-onset period and the negative association for between-person behavior scores with child glycated hemoglobin suggest that clinics should consider screening parents for FH, especially among parents of children with lower glycemic levels.
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Affiliation(s)
- Alexandra D Monzon
- Center for Healthcare Delivery Science, Nemours Children's Health, Orlando, FL, USA
| | - Shideh Majidi
- Division of Endocrinology, Children's National Hospital, Washington, DC, USA
| | - Mark A Clements
- Division of Endocrinology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, FL, USA.
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Zeitoun MH, Abdel Reheem AA, Kharboush IF, Sheshtawy H, Assad DH, El Feky AY. Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus. Prim Care Diabetes 2023; 17:255-259. [PMID: 36925404 DOI: 10.1016/j.pcd.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND AIMS Emotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH. METHODS This study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications. RESULTS The prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score. CONCLUSIONS FOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.
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Affiliation(s)
| | | | - Ibrahim F Kharboush
- Department of Maternal and Child Health, High Institute of Public Health, Alexandria University, Egypt
| | - Hesham Sheshtawy
- Department of Neurology and Psychiatry, Alexandria University, Egypt
| | - Dalia H Assad
- Department of Internal Medicine, Abu Qir general hospital, Alexandria, Egypt
| | - Amr Y El Feky
- Department of Internal Medicine, Alexandria University, Egypt.
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Cigrovski Berkovic M, Bilic-Curcic I, La Grasta Sabolic L, Mrzljak A, Cigrovski V. Fear of hypoglycemia, a game changer during physical activity in type 1 diabetes mellitus patients. World J Diabetes 2021; 12:569-577. [PMID: 33995845 PMCID: PMC8107983 DOI: 10.4239/wjd.v12.i5.569] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus (T1DM). Fear of hypoglycemia (FoH) is a significant psychosocial consequence that negatively impacts the willingness of T1DM patients to engage in and profit from the health benefits of regular physical activity (e.g., cardiometabolic health, improved body composition, cardiovascular fitness, quality of life). Technological advances, improved insulin regimens, and a better understanding of the physiology of various types of exercise could help ameliorate FoH. This narrative review summarizes the available literature on FoH in children and adults and tools to avoid it.
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Affiliation(s)
- Maja Cigrovski Berkovic
- Department of Endocrinology, Diabetes, Metabolism and Clinical Pharmacology, University Hospital Dubrava, Zagreb 10000, Croatia
| | - Ines Bilic-Curcic
- Department of Pharmacology, Faculty of Medicine, University of J. J. Strossmayer Osijek, Osijek 31000, Croatia
| | - Lavinia La Grasta Sabolic
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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Patton SR, McConville A, Marker AM, Monzon AD, Driscoll KA, Clements MA. Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP): Protocol for a Randomized Clinical Trial to Test a Video-Based Telehealth Intervention. JMIR Res Protoc 2020; 9:e17877. [PMID: 32808936 PMCID: PMC7463405 DOI: 10.2196/17877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Despite the introduction of new insulin analogs, insulin pumps, and continuous glucose monitoring (CGM), young children with type 1 diabetes mellitus (T1D) remain vulnerable to episodes of hypoglycemia because of their unpredictable eating and activity patterns and high degree of insulin sensitivity. Caregivers and young children living with T1D learn to fear hypoglycemia because it is uncomfortable, unpredictable, and dangerous. Up to 60% of caregivers of young children with T1D report moderate to severe levels of fear of hypoglycemia, and caregiver fear of hypoglycemia relates to lower quality of life for families and suboptimal child glycemic control. Yet, until recently, there have been no studies reporting on a targeted intervention to treat caregiver fear of hypoglycemia in families of young children. Objective The aim of this project is to conduct a randomized clinical trial of an innovative, video-based telehealth intervention to treat fear of hypoglycemia in caregivers of young children with T1D versus a relevant, age-appropriate attention control intervention. Methods We created the Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP) intervention by merging age-appropriate T1D education and behavioral parenting strategies with cognitive behavioral therapy strategies that are effective for reducing fear and promoting adaptive coping. REDCHiP uses 10 video-based telehealth sessions that are a combination of group and individual sessions. We will recruit up to 180 families of young children with T1D to participate in this clinical trial from two pediatric diabetes clinics located in the midwestern and southern United States. Once families have been enrolled, we will randomize caregivers based on child age (age 2-3 years or 4-5 years), child sex, and family CGM use to participate in the REDCHiP or attention control intervention. Families will complete 3 assessment visits that coincide with study entry, end of treatment, and 3-month posttreatment. At each assessment visit, we will collect questionnaire data from caregivers, accelerometry data from caregivers and children, CGM data from children, and a blood sample to measure glycated hemoglobin levels from children. Results Recruitment began in July 2019, and enrollment is ongoing. The first wave of intervention delivery began in December 2019. We anticipate completing enrollment in 2023. Final reporting of results will occur within 12 months of the primary completion date. Conclusions If the REDCHiP intervention is efficacious, next steps will be to examine multiple implementation strategies to determine how best to disseminate the intervention to pediatric diabetes clinics around the world. Trial Registration ClinicalTrials.gov NCT03914547; https://clinicaltrials.gov/ct2/show/NCT03914547 International Registered Report Identifier (IRRID) PRR1-10.2196/17877
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Affiliation(s)
- Susana R Patton
- Nemours Children's Health System, Jacksonville, FL, United States
| | - Andrew McConville
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
| | - Arwen M Marker
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
| | - Alexandra D Monzon
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Mark A Clements
- Children's Mercy Hospital-Kansas City, Kansas City, MO, United States
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Patton SR, Clements MA, Marker AM, Nelson EL. Intervention to reduce hypoglycemia fear in parents of young kids using video-based telehealth (REDCHiP). Pediatr Diabetes 2020; 21:112-119. [PMID: 31610073 PMCID: PMC7393613 DOI: 10.1111/pedi.12934] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/16/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a new video-based telehealth intervention to reduce hypoglycemia fear in parents of young children with type 1 diabetes. METHODS We randomized 42 parents to either immediate treatment (reducing emotional distress for childhood hypoglycemia in parents, REDCHiP; n = 22) or a waitlist control (WAITLIST; n = 21) condition. REDCHiP parents completed a 10-session video-based telehealth intervention, while WAITLIST parents continued in usual care. After 14-weeks, WAITLIST parents completed the telehealth treatment. We examined for between group changes in parental hypoglycemia fear and parenting stress (n = 18 per condition), 3-month maintenance of treatment effects for parents randomized to REDCHiP (n = 15), and pre-post changes for the entire sample (n = 36). RESULTS Mostly mothers participated (97.6%). They reported a mean age of 35.2 ± 5.0 years at pre-treatment. Children were 4.4 ± 1.4 years old and 59.5% boys. Between group comparisons showed a significant reduction in hypoglycemia fear (P = .04) and a trend toward reduction in parenting stress-frequency (P = .092) for REDCHiP parents compared to WAITLIST parents. After the three-month maintenance period, REDCHiP parents reported significant reductions in hypoglycemia fear, parenting stress-frequency, and parenting stress-difficulty (P's < .01) compared to pre-treatment. When all parents received the telehealth treatment, we also observed significant reductions in hypoglycemia fear, parenting stress-frequency, and parenting stress-difficulty (P's < .001), and sensitivity analyses revealed a significant reduction in child glycated hemoglobin for children who entered the treatment above target (P < .05). CONCLUSION Our new video-based telehealth intervention appears to reduce hypoglycemia fear and parenting stress and may help parents of very young children with T1D to better achieve optimal child glycemic control when children are above target.
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Affiliation(s)
- Susana R. Patton
- University of Kansas Medical Center, Department of Pediatrics, Kansas City, KS;,Center for Children’s Healthy Lifestyles and Nutrition, Kansas City, MO
| | - Mark A. Clements
- Center for Children’s Healthy Lifestyles and Nutrition, Kansas City, MO;,Children’s Mercy-Kansas City, Division of Endocrinology, Kansas City, MO
| | - Arwen M. Marker
- University of Kansas, Clinical Child Psychology Program, Lawrence, KS
| | - Eve-Lynn Nelson
- University of Kansas Medical Center, Department of Pediatrics, Kansas City, KS
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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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Garabeli AA, Daher JB, Wiens A, Lenzi L, Pontarolo R. Quality of life perception of type 1 diabetic patients treated with insulin analogs and receiving medication review with follow-up in a public health care service from Ponta Grossa-PR, Brazil. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Driscoll KA, Raymond J, Naranjo D, Patton SR. Fear of Hypoglycemia in Children and Adolescents and Their Parents with Type 1 Diabetes. Curr Diab Rep 2016; 16:77. [PMID: 27370530 PMCID: PMC5371512 DOI: 10.1007/s11892-016-0762-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hypoglycemia is a frequent occurrence in children and adolescents with type 1 diabetes. A variety of efforts have been made to standardize the definition of hypoglycemia and to define one of its most significant psychosocial consequences-fear of hypoglycemia (FOH). In addition to documenting the experience of FOH in children and adolescents type 1 diabetes and their parents, studies have investigated the relations between FOH and glycemic control and diabetes technology use. This review provides a summary of the recent FOH literature as it applies to pediatric type 1 diabetes.
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Affiliation(s)
- Kimberly A Driscoll
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 1775 Aurora Ct, Aurora, CO, 80045, USA.
| | - Jennifer Raymond
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 1775 Aurora Ct, Aurora, CO, 80045, USA
| | - Diana Naranjo
- Department of Psychiatry & Behavioral Sciences, Division of Child & Adolescent Psychiatry & Child Development, Lucile Packard Children's Hospital, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4004, Kansas, KS, 66160, USA
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Franc A, Muselík J, Sabadková D, Neumann D. Preparation of pellets with controlled release of glucose as prevention of hypoglycaemia in paediatric patients. Eur J Pharm Sci 2015; 75:72-80. [DOI: 10.1016/j.ejps.2015.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
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Rheinheimer J, Bauer AC, Silveiro SP, Estivalet AAF, Bouças AP, Rosa AR, Souza BMD, Oliveira FSD, Cruz LA, Brondani LA, Azevedo MJ, Lemos NE, Carlessi R, Assmann TS, Gross JL, Leitão CB, Crispim D. Human pancreatic islet transplantation: an update and description of the establishment of a pancreatic islet isolation laboratory. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:161-70. [PMID: 25993680 DOI: 10.1590/2359-3997000000030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 02/23/2015] [Indexed: 11/22/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is associated with chronic complications that lead to high morbidity and mortality rates in young adults of productive age. Intensive insulin therapy has been able to reduce the likelihood of the development of chronic diabetes complications. However, this treatment is still associated with an increased incidence of hypoglycemia. In patients with "brittle T1DM", who have severe hypoglycemia without adrenergic symptoms (hypoglycemia unawareness), islet transplantation may be a therapeutic option to restore both insulin secretion and hypoglycemic perception. The Edmonton group demonstrated that most patients who received islet infusions from more than one donor and were treated with steroid-free immunosuppressive drugs displayed a considerable decline in the initial insulin independence rates at eight years following the transplantation, but showed permanent C-peptide secretion, which facilitated glycemic control and protected patients against hypoglycemic episodes. Recently, data published by the Collaborative Islet Transplant Registry (CITR) has revealed that approximately 50% of the patients who undergo islet transplantation are insulin independent after a 3-year follow-up. Therefore, islet transplantation is able to successfully decrease plasma glucose and HbA1c levels, the occurrence of severe hypoglycemia, and improve patient quality of life. The goal of this paper was to review the human islet isolation and transplantation processes, and to describe the establishment of a human islet isolation laboratory at the Endocrine Division of the Hospital de Clínicas de Porto Alegre - Rio Grande do Sul, Brazil.
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Affiliation(s)
- Jakeline Rheinheimer
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Andrea C Bauer
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Sandra P Silveiro
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline A F Estivalet
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ana P Bouças
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Annelise R Rosa
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Bianca M de Souza
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernanda S de Oliveira
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lavínia A Cruz
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Letícia A Brondani
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mirela J Azevedo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Natália E Lemos
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rodrigo Carlessi
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Taís S Assmann
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Jorge L Gross
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cristiane B Leitão
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daisy Crispim
- Laboratory of Human Pancreatic Islet Biology, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Bratina N, Shalitin S, Phillip M, Battelino T. Type 1 Diabetes in the Young: Organization of Two National Centers in Israel and Slovenia. Zdr Varst 2015; 54:139-45. [PMID: 27646921 PMCID: PMC4820167 DOI: 10.1515/sjph-2015-0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/03/2015] [Indexed: 01/25/2023] Open
Abstract
Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.
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Affiliation(s)
- Nataša Bratina
- University Children's Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Shlomit Shalitin
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel,14 Kaplan Street, Petah Tikva 4920235, Israel
| | - Moshe Phillip
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel,14 Kaplan Street, Petah Tikva 4920235, Israel
| | - Tadej Battelino
- University Children's Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Glucose-responsive insulin activity by covalent modification with aliphatic phenylboronic acid conjugates. Proc Natl Acad Sci U S A 2015; 112:2401-6. [PMID: 25675515 DOI: 10.1073/pnas.1424684112] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Since its discovery and isolation, exogenous insulin has dramatically changed the outlook for patients with diabetes. However, even when patients strictly follow an insulin regimen, serious complications can result as patients experience both hyperglycemic and hypoglycemic states. Several chemically or genetically modified insulins have been developed that tune the pharmacokinetics of insulin activity for personalized therapy. Here, we demonstrate a strategy for the chemical modification of insulin intended to promote both long-lasting and glucose-responsive activity through the incorporation of an aliphatic domain to facilitate hydrophobic interactions, as well as a phenylboronic acid for glucose sensing. These synthetic insulin derivatives enable rapid reversal of blood glucose in a diabetic mouse model following glucose challenge, with some derivatives responding to repeated glucose challenges over a 13-h period. The best-performing insulin derivative provides glucose control that is superior to native insulin, with responsiveness to glucose challenge improved over a clinically used long-acting insulin derivative. Moreover, continuous glucose monitoring reveals responsiveness matching that of a healthy pancreas. This synthetic approach to insulin modification could afford both long-term and glucose-mediated insulin activity, thereby reducing the number of administrations and improving the fidelity of glycemic control for insulin therapy. The described work is to our knowledge the first demonstration of a glucose-binding modified insulin molecule with glucose-responsive activity verified in vivo.
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Wadams H, Cherñavvsky DR, Lteif A, Basu A, Kovatchev BP, Kudva YC, DeBoer MD. Closed-loop control for pediatric Type 1 diabetes mellitus. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/dmt.14.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hemoglobin A1c Levels and risk of severe hypoglycemia in children and young adults with type 1 diabetes from Germany and Austria: a trend analysis in a cohort of 37,539 patients between 1995 and 2012. PLoS Med 2014; 11:e1001742. [PMID: 25289645 PMCID: PMC4188517 DOI: 10.1371/journal.pmed.1001742] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/19/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Severe hypoglycemia is a major complication of insulin treatment in patients with type 1 diabetes, limiting full realization of glycemic control. It has been shown in the past that low levels of hemoglobin A1c (HbA1c), a marker of average plasma glucose, predict a high risk of severe hypoglycemia, but it is uncertain whether this association still exists. Based on advances in diabetes technology and pharmacotherapy, we hypothesized that the inverse association between severe hypoglycemia and HbA1c has decreased in recent years. METHODS AND FINDINGS We analyzed data of 37,539 patients with type 1 diabetes (mean age ± standard deviation 14.4 ± 3.8 y, range 1-20 y) from the DPV (Diabetes Patienten Verlaufsdokumentation) Initiative diabetes cohort prospectively documented between January 1, 1995, and December 31, 2012. The DPV cohort covers an estimated proportion of >80% of all pediatric diabetes patients in Germany and Austria. Associations of severe hypoglycemia, hypoglycemic coma, and HbA1c levels were assessed by multivariable regression analysis. From 1995 to 2012, the relative risk (RR) for severe hypoglycemia and coma per 1% HbA1c decrease declined from 1.28 (95% CI 1.19-1.37) to 1.05 (1.00-1.09) and from 1.39 (1.23-1.56) to 1.01 (0.93-1.10), respectively, corresponding to a risk reduction of 1.2% (95% CI 0.6-1.7, p<0.001) and 1.9% (0.8-2.9, p<0.001) each year, respectively. Risk reduction of severe hypoglycemia and coma was strongest in patients with HbA1c levels of 6.0%-6.9% (RR 0.96 and 0.90 each year) and 7.0%-7.9% (RR 0.96 and 0.89 each year). From 1995 to 2012, glucose monitoring frequency and the use of insulin analogs and insulin pumps increased (p<0.001). Our study was not designed to investigate the effects of different treatment modalities on hypoglycemia risk. Limitations are that associations between diabetes education and physical activity and severe hypoglycemia were not addressed in this study. CONCLUSIONS The previously strong association of low HbA1c with severe hypoglycemia and coma in young individuals with type 1 diabetes has substantially decreased in the last decade, allowing achievement of near-normal glycemic control in these patients. Please see later in the article for the Editors' Summary.
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Ang M, Meyer C, Brendel MD, Bretzel RG, Linn T. Magnitude and mechanisms of glucose counterregulation following islet transplantation in patients with type 1 diabetes suffering from severe hypoglycaemic episodes. Diabetologia 2014; 57:623-32. [PMID: 24305963 DOI: 10.1007/s00125-013-3120-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/08/2013] [Indexed: 01/05/2023]
Abstract
AIMS/HYPOTHESIS Pancreatic islet transplantation stabilises glycaemic control in type 1 diabetes mellitus patients with neuroglycopoenia, despite them not achieving insulin independence because of limited graft function. However, the extent and underlying metabolic pathways of restored glucose counterregulation are unknown. We therefore compared systemic glucose turnover, including lactate gluconeogenesis (GN) and muscle glucose uptake, in individuals with type 1 diabetes who were transplant recipients with partial graft function (T1DM/ITx(+)), matched non-transplanted individuals with type 1 diabetes (T1DM/ITx(-)) and matched healthy non-diabetic individuals. METHODS Participants (n = 12 in each group) underwent a euglycaemic and a hypoglycaemic (2.5-2.8 mmol/l) hyperinsulinaemic clamp (0.8 mU kg(-1) min(-1)) in a randomised crossover fashion. Systemic and skeletal muscle glucose and lactate kinetics were assessed using a combination of isotopic and forearm balance techniques. RESULTS Whole-body glucose counterregulation, the difference in glucose infusion rates required to maintain the glycaemic goal between the hypoglycaemic and euglycaemic clamps, was improved in T1DM/ITx(+) (7.8 ± 1.3 μmol kg(-1) min(-1)) compared with T1DM/ITx(-) (0.3 ± 0.9 μmol kg(-1) min(-1)), but was ~45% lower than in controls (14.1 ± 2.1 μmol kg(-1) min(-1)). Increased endogenous glucose production (EGP) and decreased systemic glucose disposal accounted for 49% and 39% of glucose counterregulation in T1DM/ITx(+), respectively, compared with 60% and 36% in controls. Lactate GN increased in T1DM/ITx(+) (2.7 ± 0.4 μmol kg(-1) min(-1)) and controls (1.7 ± 0.5 μmol kg(-1) min(-1)), such that it accounted for 70% and 20% of the increased EGP, respectively. Skeletal muscle accounted for similar proportions of the decrease in systemic glucose disposal in controls (49%) and T1DM/ITx(+) (41%). CONCLUSIONS/INTERPRETATION Partial islet graft function improves hypoglycaemia counterregulation by increasing EGP, largely via lactate GN and decreasing systemic glucose disposal. This may explain the reduction in severe hypoglycaemic events in T1DM/ITx(+) individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT01668485.
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Affiliation(s)
- Meidjie Ang
- Clinical Research Unit, Medical Clinic and Policlinic III, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
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Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A. Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database Syst Rev 2014; 2014:CD009122. [PMID: 24526393 PMCID: PMC6486147 DOI: 10.1002/14651858.cd009122.pub2] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical guidelines differ regarding their recommended blood glucose targets for patients with type 1 diabetes and recent studies on patients with type 2 diabetes suggest that aiming at very low targets can increase the risk of mortality. OBJECTIVES To assess the effects of intensive versus conventional glycaemic targets in patients with type 1 diabetes in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit. SEARCH METHODS A systematic literature search was performed in the databases The Cochrane Library, MEDLINE and EMBASE. The date of the last search was December 2012 for all databases. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that had defined different glycaemic targets in the treatment arms, studied patients with type 1 diabetes, and had a follow-up duration of at least one year. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed studies for risk of bias, with differences resolved by consensus. Overall study quality was evaluated by the 'Grading of Recommendations Assessment, Development, and Evaluation' (GRADE) system. Random-effects models were used for the main analyses and the results are presented as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. MAIN RESULTS We identified 12 trials that fulfilled the inclusion criteria, including a total of 2230 patients. The patient populations varied widely across studies with one study only including children, one study only including patients after a kidney transplant, one study with newly diagnosed adult patients, and several studies where patients had retinopathy or microalbuminuria at baseline. The mean follow-up duration across studies varied between one and 6.5 years. The majority of the studies were carried out in the 1980s and all trials took place in Europe or North America. Due to the nature of the intervention, none of the studies could be carried out in a blinded fashion so that the risk of performance bias, especially for subjective outcomes such as hypoglycaemia, was present in all of the studies. Fifty per cent of the studies were judged to have a high risk of bias in at least one other category.Under intensive glucose control, the risk of developing microvascular complications was reduced compared to conventional treatment for a) retinopathy: 23/371 (6.2%) versus 92/397 (23.2%); RR 0.27 (95% CI 0.18 to 0.42); P < 0.00001; 768 participants; 2 trials; high quality evidence; b) nephropathy: 119/732 (16.3%) versus 211/743 (28.4%); RR 0.56 (95% CI 0.46 to 0.68); P < 0.00001; 1475 participants; 3 trials; moderate quality evidence; c) neuropathy: 29/586 (4.9%) versus 86/617 (13.9%); RR 0.35 (95% CI 0.23 to 0.53); P < 0.00001; 1203 participants; 3 trials; high quality evidence. Regarding the progression of these complications after manifestation, the effect was weaker (retinopathy) or possibly not existent (nephropathy: RR 0.79 (95% CI 0.37 to 1.70); P = 0.55; 179 participants with microalbuminuria; 3 trials; very low quality evidence); no adequate data were available regarding the progression of neuropathy. For retinopathy, intensive glucose control reduced the risk of progression in studies with a follow-up duration of at least two years (85/366 (23.2%) versus 154/398 (38.7%); RR 0.61 (95% CI 0.49 to 0.76); P < 0.0001; 764 participants; 2 trials; moderate quality evidence), while we found evidence for an initial worsening of retinopathy after only one year of intensive glucose control (17/49 (34.7%) versus 7/47 (14.9%); RR 2.32 (95% CI 1.16 to 4.63); P = 0.02; 96 participants; 2 trials; low quality evidence).Major macrovascular outcomes (stroke and myocardial infarction) occurred very rarely, and no firm evidence could be established regarding these outcome measures (low quality evidence).We found that intensive glucose control increased the risk for severe hypoglycaemia, however the results were heterogeneous and only the 'Diabetes Complications Clinical Trial' (DCCT) showed a clear increase in severe hypoglycaemic episodes under intensive treatment. A subgroup analysis according to the baseline haemoglobin A1c (HbA1c) of participants in the trials (low quality evidence) suggests that the risk of hypoglycaemia is possibly only increased for patients who started with relatively low HbA1c values (< 9.0%). Several of the included studies also showed a greater weight gain under intensive glucose control, and the risk of ketoacidosis was only increased in studies using insulin pumps in the intensive treatment group (very low quality evidence).Overall, all-cause mortality was very low in all studies (moderate quality evidence) except in one study investigating renal allograft as treatment for end-stage diabetic nephropathy. Health-related quality of life was only reported in the DCCT trial, showing no statistically significant differences between the intervention and comparator groups (moderate quality evidence). In addition, only the DCCT published data on costs, indicating that intensive glucose therapy control was highly cost-effective considering the reduction of potential diabetes complications (moderate quality evidence). AUTHORS' CONCLUSIONS Tight blood sugar control reduces the risk of developing microvascular diabetes complications. The evidence of benefit is mainly from studies in younger patients at early stages of the disease. Benefits need to be weighed against risks including severe hypoglycaemia, and patient training is an important aspect in practice. The effects of tight blood sugar control seem to become weaker once complications have been manifested. However, further research is needed on this issue. Furthermore, there is a lack of evidence from RCTs on the effects of tight blood sugar control in older patient populations or patients with macrovascular disease. There is no firm evidence for specific blood glucose targets and treatment goals need to be individualised taking into account age, disease progression, macrovascular risk, as well as the patient's lifestyle and disease management capabilities.
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Affiliation(s)
- Birgit Fullerton
- Goethe UniversityInstitute of General PracticeTheodor‐Stern‐Kai 7Frankfurt am MainHesseGermany60590
| | - Klaus Jeitler
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Institute of Medical Informatics, Statistics and DocumentationAuenbruggerplatz 2/9GrazAustria8036
| | | | - Karl Horvath
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Department of Internal Medicine, Division of Endocrinology and MetabolismAuenbruggerplatz 2/9GrazAustria8036
| | - Andrea Berghold
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Institute of Medical Informatics, Statistics and DocumentationAuenbruggerplatz 2/9GrazAustria8036
| | - Andrea Siebenhofer
- Graz, Austria / Institute of General Practice, Goethe UniversityInstitute of General Practice and Evidence‐Based Health Services Research, Medical University of GrazFrankfurt am MainGermany
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De Feyter HM, Mason GF, Shulman GI, Rothman DL, Petersen KF. Increased brain lactate concentrations without increased lactate oxidation during hypoglycemia in type 1 diabetic individuals. Diabetes 2013; 62:3075-80. [PMID: 23715622 PMCID: PMC3749358 DOI: 10.2337/db13-0313] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous studies have reported that brain metabolism of acetate is increased more than twofold during hypoglycemia in type 1 diabetic (T1D) subjects with hypoglycemia unawareness. These data support the hypothesis that upregulation of blood-brain barrier monocarboxylic acid (MCA) transport may contribute to the maintenance of brain energetics during hypoglycemia in subjects with hypoglycemia unawareness. Plasma lactate concentrations are ∼10-fold higher than acetate concentrations, making lactate the most likely alternative MCA as brain fuel. We therefore examined transport of [3-(13)C]lactate across the blood-brain barrier and its metabolism in the brains of T1D patients and nondiabetic control subjects during a hypoglycemic clamp using (13)C magnetic resonance spectroscopy. Brain lactate concentrations were more than fivefold higher (P < 0.05) during hypoglycemia in the T1D subjects compared with the control subjects. Surprisingly, we observed no increase in the oxidation of blood-borne lactate in the T1D subjects, as reflected by similar (13)C fractional enrichments in brain glutamate and glutamine. Taken together, these data suggest that in addition to increased MCA transport at the blood-brain barrier, there may be additional metabolic adaptations that contribute to hypoglycemia unawareness in patients with T1D.
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Affiliation(s)
- Henk M. De Feyter
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Graeme F. Mason
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gerald I. Shulman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut
- Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut
| | - Douglas L. Rothman
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
- Department of Biomedical Engineering, Yale University School of Medicine, New Haven, Connecticut
| | - Kitt Falk Petersen
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Corresponding author: Kitt Falk Petersen,
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Maltoni G, Zucchini S, Scipione M, Rollo A, Balsamo C, Bertolini C, Baronio F, Rondelli R, Pession A. Severe hypoglycemic episodes: a persistent threat for children with Type 1 diabetes mellitus and their families. J Endocrinol Invest 2013; 36:617-21. [PMID: 23511311 DOI: 10.3275/8896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND As lowering glycated hemoglobin (HbA1c) levels is still the main goal of insulin treatment, severe hypoglycemia (SH) remains a common experience in children with Type 1 diabetes mellitus (T1DM) and their families. AIM This study aims to evaluate the incidence and the clinical features of SH episodes in our Centre in the last 20 yr. SUBJECTS AND METHODS We analyzed SH incidence in 269 patients (pts) diagnosed from 1990 to 2010 (total follow-up 2212.9 pts/yr). Inclusion criteria were at least 3 visits/yr and 1-yr follow- up. SH episode was defined as any condition of low blood glucose requiring third-party assistance. RESULTS 50.2% of patients experienced at least 1 SH episode for a total of 345 episodes. Whole incidence was 15.6/100 pts/yr, slightly different between first and second decade (12.6 vs 16.5, p=0.047). HbA1c at the time of SH was lower in the non-basal bolus group (7.4±1.3 vs 8.2±1.4; p=0.0001) and worsened 3 months later (p=0.0001). Impaired awareness was the main or only symptom in 43.5%. SH occurred at night in 32% of patients; they were significantly younger than those with SH at other times. Five SH episodes or more occurred in 8.1% of patients who presented a lower HbA1c, a younger age and shorter disease duration than the other patients. HbA1c at first SH was negatively correlated with number of SH (r=-0.20; p=0.05). CONCLUSIONS Despite the advent of new insulin regimens, we confirm that SH still represents a relevant risk and a current threat for patients with T1DM and their families.
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Affiliation(s)
- G Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy.
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Super long-term glycemic control in diabetic rats by glucose-sensitive LbL films constructed of supramolecular insulin assembly. Biomaterials 2012; 33:8733-42. [DOI: 10.1016/j.biomaterials.2012.08.041] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 08/17/2012] [Indexed: 12/28/2022]
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Penfornis A, Personeni E, Tiv M, Monnier C, Meillet L, Combes J, Mouret C, Picard S. Quality of care of patients with type 1 diabetes: population-based results in a French region. DIABETES & METABOLISM 2012; 38:436-43. [PMID: 22749623 DOI: 10.1016/j.diabet.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
AIM Although the incidence of type 1 diabetes (T1D) has been increasing, little is known of its quality of care. Thus, our survey was designed to retrospectively evaluate this issue in French patients. METHODS Patients with T1D living in northeastern France were identified thanks to the healthcare system (CPAM) database, and the resulting list reviewed by local diabetes specialists. All of the listed patients and their primary physicians were asked to fill in a questionnaire including clinical data, laboratory results and follow-up habits. The 'optimized results' included CPAM-based results plus any specialized care provided during hospitalizations in diabetes and non-diabetes units, according to questionnaire data. RESULTS A total of 227 individuals, for whom CPAM data were available, were identified as having T1D. From these patients, 174 questionnaires were answered, and optimized results (having both CPAM data and a completely filled-in questionnaire) were available for 149 patients. Of the 169 patients who responded, 71.3% reported at least a yearly visit with a diabetologist. This number reached 77.9% when optimized results were considered. Patients who received specialized care were younger, underwent HbA(1c) tests more often and were more frequently on optimal treatment; however, there was no difference in HbA(1c) values or in the prevalence of complications. Eye examinations and kidney tests had been performed at least once over the 2-year period in more than 87% of the patients, whereas around 30%, 21% and 23% had an eye exam, creatinine test and urinary albumin excretion measurement, respectively, only once over the same time period. CONCLUSION This is the first large-scale study of the quality of care in patients with T1DM in France, and it could serve as a preliminary survey for a national study. Although the follow-up was better than previously reported, there is still considerable room for improvement.
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Affiliation(s)
- A Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, EA 3920, University of Franche-Comté, 25030 Besançon cedex, France.
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Comparative effects of short-term and long-term insulin-induced hypoglycemia on glucose production in the perfused livers of weaned rats. Pharmacol Rep 2012; 63:1252-7. [PMID: 22180370 DOI: 10.1016/s1734-1140(11)70647-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 05/16/2011] [Indexed: 01/10/2023]
Abstract
The liver glucose production (LGP) levels of 15-h overnight fasted weaned rats submitted to short-term insulin-induced hypoglycemia (ST-IIH) and long-term IIH (LT-IIH) were compared. Experiments to characterize ST-IIH or LT-IIH that followed an intraperitoneal (ip) injection (1.0 U/kg) of regular (ST-IIH) or insulin detemir (LT-IIH) were performed and glycemia were measured 0 (normoglycemic control), 0.5 h (ST-IIH), 4 h and 6 h (LT-IIH) later. The values of glycemia (mg/dl) were 77.8 ±l 7.2 (normoglycemic control), 26.2 ±l 6.1 (ST IIH 0.5 h), 21.2 ±l 7.6 (LT-IIH 4 h) and 35.3 ±l 14.5 (LT-IIH 6.0). The LGP levels were measured in the rats submitted to ST-IIH (0.5 h) and LT-IIH (4 h or 6 h). The rats that received ip saline were used as the normoglycemic control group (COG). The livers from the COG and IIH groups (ST-IIH or LT-IIH) were perfused in situ with infusion of L-alanine (5 mM), L-glutamine (10 mM), glutamine dipeptide (5 mM), L-lactate (2 mM) or glycerol (2 mM). The ST-IIH rats showed a higher LGP level than COG group following the L-glutamine infusion (p < 0.05), but the LGP levels that were measured following the L-lactate, L-alanine, glutamine dipeptide (5 mM), L-lactate (2 mM) or glycerol infusion remained unchanged. Moreover, if the period of IIH was expanded to 4 h following insulin injection, the LGP levels induced by L-alanine, glutamine dipeptide or glycerol infusion also increased (p < 0.05, LT-IIH vs. COG). However, the LGP from the L-lactate infusion remained unchanged until 6 h after insulin injection. In conclusion, these results suggest that the intensification of liver gluconeogenesis during ST-IIH and LT-IIH in weaned rats is not a synchronous "all or nothing" process; instead, this process integrated in a temporal manner and is specific for each gluconeogenic substrate.
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Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 2011; 34:795-800. [PMID: 21335621 PMCID: PMC3064030 DOI: 10.2337/dc10-1989] [Citation(s) in RCA: 324] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of continuous glucose monitoring on hypoglycemia in people with type 1 diabetes. RESEARCH DESIGN AND METHODS In this randomized, controlled, multicenter study, 120 children and adults on intensive therapy for type 1 diabetes and a screening level of glycated hemoglobin A(1c) (HbA(1c)) <7.5% were randomly assigned to a control group performing conventional home monitoring with a blood glucose meter and wearing a masked continuous glucose monitor every second week for five days or to a group with real-time continuous glucose monitoring. The primary outcome was the time spent in hypoglycemia (interstitial glucose concentration <63 mg/dL) over a period of 26 weeks. Analysis was by intention to treat for all randomized patients. RESULTS The time per day spent in hypoglycemia was significantly shorter in the continuous monitoring group than in the control group (mean ± SD 0.48 ± 0.57 and 0.97 ± 1.55 h/day, respectively; ratio of means 0.49; 95% CI 0.26-0.76; P = 0.03). HbA(1c) at 26 weeks was lower in the continuous monitoring group than in the control group (difference -0.27%; 95% CI -0.47 to -0.07; P = 0.008). Time spent in 70 to 180 mg/dL normoglycemia was significantly longer in the continuous glucose monitoring group compared with the control group (mean hours per day, 17.6 vs. 16.0, P = 0.009). CONCLUSIONS Continuous glucose monitoring was associated with reduced time spent in hypoglycemia and a concomitant decrease in HbA(1c) in children and adults with type 1 diabetes.
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Affiliation(s)
- Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, Faculty of Medicine, University Medical Centre-University Children’s Hospital, University of Ljubljana, Ljubljana, Slovenia.
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Lipids, lipid-lowering therapy and diabetes complications. DIABETES & METABOLISM 2011; 37:15-24. [DOI: 10.1016/j.diabet.2010.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/30/2010] [Accepted: 10/01/2010] [Indexed: 01/23/2023]
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Supramolecular insulin assembly II for a sustained treatment of type 1 diabetes mellitus. Proc Natl Acad Sci U S A 2010; 107:13246-51. [PMID: 20628017 DOI: 10.1073/pnas.1005704107] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Diabetes is a chronic disease requiring continuous medical supervision and patient education to prevent acute secondary complications. In this study, we have harnessed the inherent property of insulin to aggregate into an oligomeric intermediate on the pathway to amyloid formation, to generate a form that exhibits controlled and sustained release for extended periods. Administration of a single dose of the insulin oligomer, defined here as the supramolecular insulin assembly II (SIA-II), to experimental animals rendered diabetic by streptozotocin or alloxan, released the hormone capable of maintaining physiologic glucose levels for >120 days for bovine and >140 days for recombinant human insulin without fasting hypoglycemia. Moreover, the novel SIA-II described here not only improved the glycemic control, but also reduced the extent of secondary diabetic complications.
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Vantyghem MC, Balavoine AS, Kerr-Conte J, Pattou F, Noel C. Who should benefit from diabetes cell therapy? ANNALES D'ENDOCRINOLOGIE 2009; 70:443-8. [PMID: 19744642 DOI: 10.1016/j.ando.2009.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 08/08/2009] [Indexed: 10/20/2022]
Abstract
Type 1 diabetes are intrinsically unstable conditions because of the loss of both insulin secretion and glucose sensing. Guidelines to treat type 1 diabetes have become stricter since the Diabetes Control and Complications Trial (DCCT) results demonstrated the close relationship between microangiopathy and HbA1c levels, whereas the deleterious role of glucose variability on macroangiopathy has been more recently suspected. Therapeutic strategies first require the treatment of underlying organic causes of the brittleness whenever possible and, secondly, the optimization of insulin therapy using analogues, multiple injections and consideration of continuous subcutaneous insulin infusion. Alternative approaches may still be needed for the most severely affected patients, including islet transplantation. We propose islet after kidney transplantation in diabetic patients with end-stage kidney disease ineligible for double kidney-pancreas transplantation (i.e C peptide negative patients over 45 years of age or with severe macroangiopathy) if creatinine blood levels are stable below 20mg/l at least six months after kidney transplantation and steroid discontinuation. Islet transplantation alone is proposed to (1) C peptide negative diabetic patients, (2) aged 18-65 with a duration of diabetes of at least five years, (3) treated with intensive subcutaneous insulin therapy, but unable to obtain a glycated hemoglobin level below 7% without hypoglycemia and / or with brittleness and unpredictable hyper- and hypoglycemia altering quality of life, (4) with normal body weight (< 80 kg) and / or low daily insulin needs (the lower, the better), (5) with renal function close to normal (creatinine clearance above 60 ml/min with albuminuria lower than 300 mg/24 h), (6) with no desire for pregnancy in women. Currently and until more complete assessment of the 5-year overall benefit-risk ratio, islet transplantation remains a clinical research procedure. As already provided for other types of transplantation, and once recognized as a "routine" procedure, prioritization of enlisted patients for islet transplantation could be aided by the calculation of a score that should be determined by a multidisciplinary team.
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Affiliation(s)
- M C Vantyghem
- INSERM U 859, Endocrinology and Metabolism, Endocrine Surgery and Nephrology Department, Lille University Hospital, 59037 Lille cedex, France.
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Logtenberg SJ, Kleefstra N, Houweling ST, Groenier KH, Gans RO, van Ballegooie E, Bilo HJ. Improved glycemic control with intraperitoneal versus subcutaneous insulin in type 1 diabetes: a randomized controlled trial. Diabetes Care 2009; 32:1372-7. [PMID: 19429874 PMCID: PMC2713651 DOI: 10.2337/dc08-2340] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump has been available for the past 25 years. CIPII, with its specific pharmacodynamic properties, may be a viable treatment alternative to improve glycemic control in patients with type 1 diabetes for whom other therapies have failed. There have been few studies in which CIPII was compared with subcutaneous insulin treatment for patients with type 1 diabetes with poor glycemic control. RESEARCH DESIGN AND METHODS In an open-label, prospective, crossover, randomized, 16-month study, the effects of CIPII and subcutaneous insulin were compared in 24 patients. The primary outcome measure was the incidence of hypoglycemia. Secondary outcome measures were A1C, and glucose profile, including time in euglycemia, as measured by continuous glucose monitoring. RESULTS The incidence of grade 1 hypoglycemic events was 4.0 +/- 2.6 per week with subcutaneous insulin compared with 3.5 +/- 2.3 per week during CIPII (P = 0.13). The absolute mean difference in A1C with CIPII compared with subcutaneous treatment was -0.76% (95% CI -1.41 to -0.11) (P = 0.03). Baseline time spent in euglycemia was 45.2 +/- 12.6% and increased 10.9% (4.6-17.3) with CIPII compared with subcutaneous treatment (absolute value; P = 0.003). There were no differences in the occurrence rate for severe hypoglycemic events, daily insulin use, or BMI. No pump or catheter malfunction was observed during the study. CONCLUSIONS Although we did not observe a significant reduction in hypoglycemic events, improved glycemic control was achieved with the use of CIPII. We saw a 0.8% decrease in A1C and an 11% increase in the time spent in euglycemia.
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Eliaschewitz FG, Franco DR. [Does brittle diabetes exist as a clinical entity?]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2009; 53:466-469. [PMID: 19649386 DOI: 10.1590/s0004-27302009000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 01/21/2009] [Indexed: 05/28/2023]
Abstract
The best comprehension about the instability of the glycemia levels in type 1 diabetes mellitus (T1DM) patients and the availability of new alternatives to successfully control it, like insulin pump therapy and the insulin analogues, underlined the questions about the brittle diabetes existence as a clinical entity as well as the necessity of define it. The aim of this article was to describe the concept of brittle diabetes in the light of the latest advances in the treatment of type 1 diabetes and propose objective criteria to evaluate the level of glucose liability.
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Oliveira-Yamashita F, Garcia RF, Felisberto-Junior AM, Curi R, Bazotte RB. Evidence that L-glutamine is better than L-alanine as gluconeogenic substrate in perfused liver of weaned fasted rats submitted to short-term insulin-induced hypoglycaemia. Cell Biochem Funct 2009; 27:30-4. [DOI: 10.1002/cbf.1530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mineo D, Sageshima J, Burke GW, Ricordi C. Minimization and withdrawal of steroids in pancreas and islet transplantation. Transpl Int 2008; 22:20-37. [PMID: 18855850 DOI: 10.1111/j.1432-2277.2008.00761.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
For reducing the corticosteroid (CS)-related side-effects, especially cardiovascular events, CS-sparing protocols have become increasingly common in pancreas transplantation (PT). Lympho-depleting induction antibodies, such as rabbit anti-thymocyte globulin (rATG) or alemtuzumab, have been widely used in successful trials. The results of various CS-sparing protocols combining calcineurin inhibitors (CNI) and mycophenolate or sirolimus, have been mixed for rejection and survival rates. Most of the studies were uncontrolled trials of low-risk patients, therefore the grade of evidence is limited. Large-scale prospective studies with long-term follow up are necessary to assess risks and benefits of CS-sparing regimens in PT before recommending such strategies as standard practice. Islet allo-transplantation for patients with brittle type 1 diabetes mellitus, less invasive and safer procedure than PT, has been attempted since late 1980s, but diabetogenic immunosuppressants at maintenance, mainly CS and high-dose CNI, prevented satisfactory results (10% insulin-independence at 1-year post-transplant). Since 2000, CS-free and CNI-reducing protocols, including more potent induction [daclizumab, OKT3gamma1(ala-ala) anti-CD3 antibody, rATG] and maintenance (sirolimus, mycophenolate) agents, have significantly improved short-term outcomes whereas long-term are still inadequate (from 80% to 20% insulin-independence from 1- to 5-year post-transplant). Main limitations are allo- and autoimmunity, immunosuppression-related islet and systemic toxicity and transplant site unsuitability, which tolerogenic protocols and biotechnological solutions may solve.
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Affiliation(s)
- Davide Mineo
- Diabetes Research Institute, University of Miami, FL 33136, USA
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