1
|
Adolfsson P, Heringhaus A, Sjunnesson K, Mehkri L, Bolin K. Cost-effectiveness of the tandem t: Slim X2 with control-IQ technology automated insulin delivery system in children and adolescents with type 1 diabetes in Sweden. Diabet Med 2024; 41:e15432. [PMID: 39239975 DOI: 10.1111/dme.15432] [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: 12/27/2023] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
AIMS The present analysis estimated the cost-effectiveness of treatment with the Tandem t: slim X2 insulin pump with Control IQ technology (CIQ) in children with type 1 diabetes in Sweden. METHODS A four-state Markov model and probabilistic sensitivity analyses (PSA) were used to assess the cost-effectiveness of CIQ use compared with treatment with multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII) in conjunction with CGM. Data sources included clinical input data from a recent retrospective, observational study, cost data from local diabetes supply companies and government agencies, and published literature. Outcomes measures were quality adjusted life years (QALYs) at 10, 20 and 30-year time horizons based on cost per QALY and incremental cost-effectiveness ratio (ICER). RESULTS A total of 84 type 1 diabetes children were included (CIQ, n = 37; MDI, n = 19; CSII, n = 28). For all time horizons, the use of CIQ was a dominant strategy (e.g. more effective and less costly) compared with MDI or CSII use: 10-year ICER, SEK -88,010.37 and SEK -91,723.92; 20-year ICER, SEK -72,095.33 and SEK -87,707.79; and 30-year ICER, SEK -65,573.01 and SEK -85,495.68, respectively. PSA confirmed that CIQ use was less costly compared with MDI and CSII. CONCLUSIONS Initiation of CIQ use in children with type 1 diabetes is cost-saving, besides previously shown improved glycaemic control, and increased quality of life. Further investigations are needed to more fully elucidate the cost-effectiveness of these technologies in different countries with existing differences in payment models.
Collapse
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, The hospital of Halland Kungsbacka, Kungsbacka, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alina Heringhaus
- Department of Pediatrics, The hospital of Halland Kungsbacka, Kungsbacka, Sweden
| | - Karin Sjunnesson
- Department of Pediatrics, The hospital of Halland Kungsbacka, Kungsbacka, Sweden
| | | | - Kristian Bolin
- MedEngine DK ApS, Copenhagen, Denmark
- Department of Economics, Centre for Health Governance, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Aydın Aİ, Öztaş G, Atak M, Özyazıcıoğlu N, Sağlam H. The effect of social support and parental monitoring on glycaemic control in adolescents with type 1 diabetes mellitus. J Eval Clin Pract 2024. [PMID: 39440968 DOI: 10.1111/jep.14190] [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: 07/29/2024] [Revised: 09/02/2024] [Accepted: 09/25/2024] [Indexed: 10/25/2024]
Abstract
RATIONALE Glycaemic control is a crucial aspect of managing type 1 diabetes mellitus (T1DM). Strict glycaemic control has been proven to reduce the long-term complications of the disease. AIMS The aim of this study was to investigate the effect of parental involvement in diabetes care and social support on glycaemic control in adolescents with T1DM. METHODS In this cross-sectional study, 94 adolescents and their parents admitted to a university hospital between January and July 2023 were included in the study. The Multidimensional Scale of Perceived Social Support (PMDC-R) and Parental Monitoring Scale (MSPSS) in Diabetes Care of Adolescents with T1DM were used as data collection tools. RESULTS Females constituted 63.8% of the adolescents who participated in the study and the glycaemic control of females was significantly lower than males (p < 0.05). The mean HbA1c of the adolescents was 8.65 + 1.57. In the study, PMDC-R and MSPSS scores of adolescents with good and poor glycaemic control were compared. The PMDC-R of the good control group were statistically significantly higher than the poor control group (p < 0.05), but there was no significant difference between the MSPSS scores. CONCLUSION Parental supervision plays a protective role in adolescents, and glycaemic control is better as parental supervision increases. Paediatric nurses should collaborate with parents in diabetes management. This approach may help adolescents to be more successful in diabetes management.
Collapse
Affiliation(s)
- Ayla İrem Aydın
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, Bursa, Turkey
| | - Gülay Öztaş
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, Bursa, Turkey
| | - Meryem Atak
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, Bursa, Turkey
| | - Nurcan Özyazıcıoğlu
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, Bursa, Turkey
| | - Halil Sağlam
- Department of Pediatric Endocrinology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| |
Collapse
|
3
|
Besser REJ, Griffin KJ. Transitioning to stage 3 type 1 diabetes: when to start insulin. Lancet Diabetes Endocrinol 2024; 12:692-694. [PMID: 39208831 DOI: 10.1016/s2213-8587(24)00238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Rachel E J Besser
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, National Institute for Health and Care Research Biomedical Research Centre, University of Oxford, Oxford OX3 7BN, UK.
| | - Kurt J Griffin
- Sanford Research and Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| |
Collapse
|
4
|
Nigi L, Simon Batzibal MDLA, Cataldo D, Dotta F. 12-Month Time in Tight Range Improvement with Advanced Hybrid-Closed Loop System in Adults with Type 1 Diabetes. Diabetes Ther 2024:10.1007/s13300-024-01656-w. [PMID: 39347899 DOI: 10.1007/s13300-024-01656-w] [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: 08/03/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
INTRODUCTION Time in tight range (TITR) is an emerging and valuable metric for assessing normoglycemia. The latest advancement in automated insulin delivery (AID) systems, the advanced hybrid closed-loop (AHCL) systems, are particularly noteworthy for managing type 1 diabetes (T1D) and enhancing glycemic control. METHODS In a real-world clinical setting, we carried out a retrospective evaluation of TITR in 42 adult subjects with T1D using the AHCL Minimed™ 780G system over a 12-month period. RESULTS Within just 14 days of activating the automatic mode, the AHCL Minimed™ 780G system showed rapid improvement in TITR, and in the other continuous glucose monitoring (CGM) metrics. This improvement persisted over 12 months, achieving the proposed 45-50% range for effective glycemic control. CONCLUSION The AHCL Minimed™ 780G system significantly enhances TITR, demonstrating continuous improvement throughout a 12-month follow-up period.
Collapse
Affiliation(s)
- Laura Nigi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
- Diabetes and Metabolic Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | | | - Dorica Cataldo
- Diabetes and Metabolic Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Dotta
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
- Diabetes and Metabolic Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| |
Collapse
|
5
|
Achenbach P, Berner R, Bonifacio E, Brämswig S, Braig S, Dunstheimer D, Ermer U, Ewald D, Gemulla G, Hauer J, Haupt F, Haus G, Hubmann M, Hummel S, Kandler M, Kordonouri O, Lange K, Laub O, Lorrmann A, Nellen-Hellmuth N, Sindichakis M, von dem Berge T, Warncke K, Weber L, Winkler C, Wintermeyer P, Ziegler AG. [Early Detection Of Type 1 Diabetes By Islet Autoantibody Screening: A Position Paper Of The Fr1daplex Project Leaders And Training Centres, Bvkj Bavaria And Paednetz (Registered) Bavaria]. DAS GESUNDHEITSWESEN 2024. [PMID: 38710228 DOI: 10.1055/a-2320-2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
This position paper is based on the authors' many years of clinical experience and basic science research on the diagnosis and treatment of children and adolescents with a presymptomatic early stage of type 1 diabetes. The benefits as well as potential disadvantages of early detection of type 1 diabetes by islet autoantibody screening are critically discussed. In addition, the perspectives of delaying the onset of the clinical metabolic disease through treatment with teplizumab are addressed. Today, we see the chance for a relevant improvement in therapeutic options and life perspectives of affected children and adolescents. Important next steps for the implementation of islet autoantibody screening in Germany are the training of pediatricians who should inform families about the screening, establishment of a few transregional laboratories that carry out the test, and expansion of regional capacities for the training and care of children with an early stage of type 1 diabetes.
Collapse
Affiliation(s)
- Peter Achenbach
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Reinhard Berner
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Dresden, Germany
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Susanne Brämswig
- Klinik für Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Sonja Braig
- Klinik für Kinder und Jugendliche, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Desiree Dunstheimer
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Uwe Ermer
- Kinder- und Jugendmedizin, Ameos Klinikum St. Elisabeth Neuburg, Neuburg an der Donau, Germany
| | - Dominik Ewald
- Bahnhofstr. 24, Kinderarztpraxis, Regensburg, Germany
| | - Gita Gemulla
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Julia Hauer
- Zentrum für Kinder und Jugendmedizin, München Klinik und Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Florian Haupt
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Gabi Haus
- Hans-Mielich-Str. 35, Kinderarztpraxis, München, Germany
| | | | - Sandra Hummel
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | | | - Olga Kordonouri
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Karin Lange
- Medizinische Psychologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Otto Laub
- Happinger Str. 98, Kinderarztpraxis, Rosenheim, Germany
| | - Anja Lorrmann
- Kinder und Jugendmedizin, KJF Klinik Josefinum GmbH, Augsburg, Germany
| | | | - Marina Sindichakis
- Klinik für Kinder- und Jugendmedizin, Kinderdiabetologie, Klinikum Traunstein, Traunstein, Germany
| | - Thekla von dem Berge
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Katharina Warncke
- Zentrum für Kinder und Jugendmedizin, München Klinik und Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Leonie Weber
- Klinik für Kinderheilkunde und Jugendmedizin, Kinderdiabetologie, Klinikum Kempten-Oberallgau GmbH, Kempten, Germany
| | - Christiane Winkler
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | | | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| |
Collapse
|
6
|
Caturano A, Nilo R, Nilo D, Russo V, Santonastaso E, Galiero R, Rinaldi L, Monda M, Sardu C, Marfella R, Sasso FC. Advances in Nanomedicine for Precision Insulin Delivery. Pharmaceuticals (Basel) 2024; 17:945. [PMID: 39065795 PMCID: PMC11279564 DOI: 10.3390/ph17070945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/07/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetes mellitus, which comprises a group of metabolic disorders affecting carbohydrate metabolism, is characterized by improper glucose utilization and excessive production, leading to hyperglycemia. The global prevalence of diabetes is rising, with projections indicating it will affect 783.2 million people by 2045. Insulin treatment is crucial, especially for type 1 diabetes, due to the lack of β-cell function. Intensive insulin therapy, involving multiple daily injections or continuous subcutaneous insulin infusion, has proven effective in reducing microvascular complications but poses a higher risk of severe hypoglycemia. Recent advancements in insulin formulations and delivery methods, such as ultra-rapid-acting analogs and inhaled insulin, offer potential benefits in terms of reducing hypoglycemia and improving glycemic control. However, the traditional subcutaneous injection method has drawbacks, including patient compliance issues and associated complications. Nanomedicine presents innovative solutions to these challenges, offering promising avenues for overcoming current drug limitations, enhancing cellular uptake, and improving pharmacokinetics and pharmacodynamics. Various nanocarriers, including liposomes, chitosan, and PLGA, provide protection against enzymatic degradation, improving drug stability and controlled release. These nanocarriers offer unique advantages, ranging from enhanced bioavailability and sustained release to specific targeting capabilities. While oral insulin delivery is being explored for better patient adherence and cost-effectiveness, other nanomedicine-based methods also show promise in improving delivery efficiency and patient outcomes. Safety concerns, including potential toxicity and immunogenicity issues, must be addressed, with the FDA providing guidance for the safe development of nanotechnology-based products. Future directions in nanomedicine will focus on creating next-generation nanocarriers with precise targeting, real-time monitoring, and stimuli-responsive features to optimize diabetes treatment outcomes and patient safety. This review delves into the current state of nanomedicine for insulin delivery, examining various types of nanocarriers and their mechanisms of action, and discussing the challenges and future directions in developing safe and effective nanomedicine-based therapies for diabetes management.
Collapse
Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Roberto Nilo
- Data Collection G-STeP Research Core Facility, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Davide Nilo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Vincenzo Russo
- Department of Biology, College of Science and Technology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, PA 19122, USA
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | | | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Luca Rinaldi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, Università degli Studi del Molise, 86100 Campobasso, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| |
Collapse
|
7
|
Pulkkinen MA, Varimo TJ, Hakonen ET, Hero MT, Miettinen PJ, Tuomaala AK. During an 18-month course of automated insulin delivery treatment, children aged 2 to 6 years achieve and maintain a higher time in tight range. Diabetes Obes Metab 2024; 26:2431-2438. [PMID: 38514384 DOI: 10.1111/dom.15562] [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: 12/04/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
AIMS To investigate whether the positive effects on glycaemic outcomes of 3-month automated insulin delivery (AID) achieved in 2- to 6-year-old children endure over an extended duration and how AID treatment affects time in tight range (TITR), defined as 3.9-7.8 mmol/L. RESEARCH DESIGN AND METHODS We analysed 18 months of follow-up data from a non-randomized, prospective, single-arm clinical trial (n = 35) conducted between 2021 and 2023. The main outcome measures were changes in time in range (TIR), glycated haemoglobin (HbA1c), time above range (TAR), TITR, and mean sensor glucose (SG) value during follow-up visits (at 0, 6, 12 and 18 months). The MiniMed 780G AID system in SmartGuard Mode was used for 18 months. Parental diabetes distress was evaluated at 3 and 18 months with the validated Problem Areas in Diabetes-Parent, revised (PAID-PR) survey. RESULTS Between 0 and 6 months, TIR and TITR increased, and HbA1c, mean SG value and TAR decreased significantly (p < 0.001); the favourable effect persisted through 18 months of follow-up. Between 3 and 18 months, PAID-PR score declined significantly (0 months: mean score 37.5; 3 months: mean score 28.6 [p = 0.06]; 18 months: mean score 24.6 [p < 0.001]). CONCLUSIONS Treatment with AID significantly increased TITR and TIR in young children. The positive effect of AID on glycaemic control observed after 6 months persisted throughout the 18 months of follow-up. Similarly, parental diabetes distress remained reduced during 18 months follow-up. These findings are reassuring and suggest that AID treatment improves glycaemic control and reduces parental diabetes distress in young children over an extended 18-month follow-up.
Collapse
Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero J Varimo
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elina T Hakonen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti T Hero
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
8
|
Calmarza P, Pérez-Ajami RI, Prieto-López C, Gallego-Royo A, García-Carro C, Lou-Francés GM. Glycemic control and study of lipid and bone metabolism in type 1 diabetic children. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:171-181. [PMID: 39079139 PMCID: PMC11361410 DOI: 10.7705/biomedica.7132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/15/2024] [Indexed: 08/04/2024]
Abstract
Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients’ lipid and bone profiles are more favorable when metabolic control of the disease is achieved.
Collapse
Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, EspañaUniversidad de ZaragozaUniversidad de ZaragozaZaragozaSpain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, EspañaInstituto de Salud Carlos IIIInstituto de Salud Carlos IIIMadridSpain
| | - Rasha Isabel Pérez-Ajami
- Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
| | - Carlos Prieto-López
- Servicio de Bioquímica Clínica, Hospital de Alcañiz, Alcañiz, EspañaHospital de AlcañizHospital de AlcañizAlcañizSpain
| | - Alba Gallego-Royo
- Servicio de Medicina Preventiva, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
| | - Celia García-Carro
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
| | - Graciela María Lou-Francés
- Centro de Salud de Barbastro, Barbastro, EspañaCentro de Salud de BarbastroCentro de Salud de BarbastroBarbastroSpain
| |
Collapse
|
9
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Gaglia JL, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S158-S178. [PMID: 38078590 PMCID: PMC10725810 DOI: 10.2337/dc24-s009] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
10
|
Castorani V, Favalli V, Rigamonti A, Frontino G, Di Tonno R, Morotti E, Sandullo F, Scialabba F, Arrigoni F, Dionisi B, Foglino R, Morosini C, Olivieri G, Barera G, Meschi F, Bonfanti R. A comparative study using insulin pump therapy and continuous glucose monitoring in newly diagnosed very young children with type 1 diabetes: it is possible to bend the curve of HbA1c. Acta Diabetol 2023; 60:1719-1726. [PMID: 37526745 DOI: 10.1007/s00592-023-02155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/03/2023] [Indexed: 08/02/2023]
Abstract
AIMS The target of metabolic control (HbA1c < 7% or 53 mmol/mol) recommended by the ADA and ISPAD is attained by 30% of children with Type 1 Diabetes (T1D). Advances in technologies for T1D aim to improve metabolic outcomes and reduce complications. This observational study assesses the long-term outcomes of advanced technologies for treatment of T1D compared to conventional approach started at onset in a group of very young children with T1D. METHODS 54 patients with less 4 years old at onset of T1D were enrolled and followed for up to 9 years after diagnosis. 24 subjects started continuous subcutaneous insulin (CSII) treatment and 30 subjects received MDI therapy from onset. Auxological data, HbA1c and total daily insulin dose (TDD/kg) have been collected at admission and every 4 months. HbA1cAUC>6%, rates of acute complications, glycemic variability indices and glucometrics were also recorded. RESULTS Patients with CSII therapy had significantly lower mean HbA1c values compared to subjects receiving MDI treatment. CSII approach also recorded lower mean HbA1cAUC>6% and TDD/kg than MDI therapy. At the last download data, the time in range (TIR) was higher in patients with CSII and hyperglycemia events were lower. Better glycemic variability indices have been described during CSII therapy, including mean glycemia, standard deviation, coefficient of variation (CV), glycemia risk index (GRI) and high blood glucose index (HBGI). There was no statistically significant difference between frequency of severe hypoglycemia and ketoacidosis episodes between groups. CONCLUSIONS Early initiation of diabetes technologies is safe and able to determine a better long term glycemic control in young children with T1D. It also allows to flatten the trajectory of HbA1c, probably reducing microvascular, macrovascular and neurological complications of diabetes in this very peculiar age group.
Collapse
Affiliation(s)
- Valeria Castorani
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Valeria Favalli
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Giulio Frontino
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Raffaella Di Tonno
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisa Morotti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Sandullo
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Francesco Scialabba
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Francesca Arrigoni
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Benedetta Dionisi
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Riccardo Foglino
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Camilla Morosini
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Gabriele Olivieri
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Graziano Barera
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Franco Meschi
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
| |
Collapse
|
11
|
Ghatak A, Boughton CK, Allen JM, Ware J, Wilinska ME, Hartnell S, Thankamony A, Randell T, Besser REJ, Elleri D, Trevelyan N, Campbell FM, Hovorka R. Closed-Loop from Diagnosis of Type 1 Diabetes in Children and Young People. Diabetes Technol Ther 2023; 25:673-674. [PMID: 37384862 DOI: 10.1089/dia.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Atrayee Ghatak
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Charlotte K Boughton
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Janet M Allen
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Julia Ware
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Malgorzata E Wilinska
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Tabitha Randell
- Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Rachel E J Besser
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniela Elleri
- Department of Diabetes and Endocrinology, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Nicola Trevelyan
- Department of Paediatrics, Southampton Children's Hospital, Southampton, United Kingdom
| | - Fiona M Campbell
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, United Kingdom
| | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
12
|
Bellido V, Aguilera E, Cardona-Hernandez R, Diaz-Soto G, González Pérez de Villar N, Picón-César MJ, Ampudia-Blasco FJ. Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes. J Diabetes Sci Technol 2023; 17:1326-1336. [PMID: 35470692 PMCID: PMC10563535 DOI: 10.1177/19322968221088601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New metrics for assessing glycemic control beyond HbA1c have recently emerged due to the increasing use of continuous glucose monitoring (CGM) in diabetes clinical practice. Among them, time in range (TIR) has appeared as a simple and intuitive metric that correlates inversely with HbA1c and has also been newly linked to the risk of long-term diabetes complications. The International Consensus on Time in Range established a series of target glucose ranges (TIR, time below range and time above range) and recommendations for time spent within these ranges for different diabetes populations. These parameters should be evaluated together with the ambulatory glucose profile (AGP). Using standardized visual reporting may help people with diabetes and healthcare professionals in the evaluation of glucose control in frequent clinical situations. The objective of the present review is to provide practical insights to quick interpretation of patient-centered metrics based on flash glucose monitoring data, as well as showing some visual examples of common clinical situations and giving practical recommendations for their management.
Collapse
Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Aguilera
- Endocrinology and Nutrition Department, Health Sciences Research Institute and University, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Gonzalo Diaz-Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
| | | | - María J. Picón-César
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Javier Ampudia-Blasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Research Foundation, Valencia, Spain
- CIBERDEM, Madrid, Spain
- Universitat de Valencia, Valencia, Spain
| |
Collapse
|
13
|
Handelsman Y, Butler J, Bakris GL, DeFronzo RA, Fonarow GC, Green JB, Grunberger G, Januzzi JL, Klein S, Kushner PR, McGuire DK, Michos ED, Morales J, Pratley RE, Weir MR, Wright E, Fonseca VA. Early intervention and intensive management of patients with diabetes, cardiorenal, and metabolic diseases. J Diabetes Complications 2023; 37:108389. [PMID: 36669322 DOI: 10.1016/j.jdiacomp.2022.108389] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
Increasing rates of obesity and diabetes have driven corresponding increases in related cardiorenal and metabolic diseases. In many patients, these conditions occur together, further increasing morbidity and mortality risks to the individual. Yet all too often, the risk factors for these disorders are not addressed promptly in clinical practice, leading to irreversible pathologic progression. To address this gap, we convened a Task Force of experts in cardiology, nephrology, endocrinology, and primary care to develop recommendations for early identification and intervention in obesity, diabetes, and other cardiorenal and metabolic diseases. The recommendations include screening and diagnosis, early interventions with lifestyle, and when and how to implement medical therapies. These recommendations are organized into primary and secondary prevention along the continuum from obesity through the metabolic syndrome, prediabetes, diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular disease (ASCVD) and atrial fibrillation, chronic kidney disease (CKD), and heart failure (HF). The goal of early and intensive intervention is primary prevention of comorbidities or secondary prevention to decrease further worsening of disease and reduce morbidity and mortality. These efforts will reduce clinical inertia and may improve patients' well-being and adherence.
Collapse
Affiliation(s)
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, TX, USA; University of Mississippi Medical Center, Jackson, MS, USA
| | - George L Bakris
- American Heart Association Comprehensive Hypertension Center, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Ralph A DeFronzo
- University of Texas Health Science Center at San Antonio, Texas Diabetes Institute, San Antonio, TX, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, UCLA Preventative Cardiology Program, UCLA Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer B Green
- Division of Endocrinology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - George Grunberger
- Grunberger Diabetes Institute, Internal Medicine and Molecular Medicine & Genetics, Wayne State University School of Medicine, Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Bloomfield Hills, MI, USA; Department of Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - James L Januzzi
- Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Cardiometabolic Trials, Baim Institute, Boston, MA, USA
| | - Samuel Klein
- Washington University School of Medicine, Saint Louis, MO, USA; Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - Pamela R Kushner
- University of California Medical Center, Kushner Wellness Center, Long Beach, CA, USA
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, TX, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Morales
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Advanced Internal Medicine Group, PC, East Hills, NY, USA
| | | | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Wright
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
14
|
Bebu I, Braffett BH, de Boer IH, Aiello LP, Bantle JP, Lorenzi GM, Herman WH, Gubitosi-Klug RA, Perkins BA, Lachin JM, Molitch ME. Relationships Between the Cumulative Incidences of Long-term Complications in Type 1 Diabetes: The DCCT/EDIC Study. Diabetes Care 2023; 46:361-368. [PMID: 36520643 PMCID: PMC9887612 DOI: 10.2337/dc22-1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the relationships between the cumulative incidences of long-term complications in individuals with type 1 diabetes (T1D) and assess whether observed associations are independent of age, duration of diabetes, and glycemic levels. METHODS Proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), reduced estimated glomerular filtration rate (eGFR), amputations, cardiovascular disease (CVD), and mortality were assessed in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study over ∼30 years. RESEARCH DESIGN AND RESULTS The cumulative incidence of complications ranged from 3% (amputations) to 37% (CSME). There were large differences in the cumulative incidence of PDR between participants with versus without prior CSME (66% vs. 15%), reduced eGFR (59% vs. 29%), and amputation (68% vs. 32%); reduced eGFR with or without prior PDR (25% vs. 9%), amputation (48% vs. 13%), and CVD (30% vs. 11%); CVD with or without prior reduced eGFR (37% vs. 14%) and amputation (50% vs. 16%); and mortality with or without prior reduced eGFR (22% vs. 9%), amputation (35% vs. 8%), and CVD (25% vs. 8%). Adjusted for age, duration of T1D, and mean updated HbA1c, the complications and associations with higher risk included PDR with CSME (hazard ratio [HR] 1.88; 95% CI 1.42, 2.50), reduced eGFR (HR 1.41; 95% CI 1.01, 1.97), and CVD (HR 1.43; 95% CI 1.06, 1.92); CSME with higher risk of PDR (HR 3.94; 95% CI 3.18 4.89), reduced eGFR (HR 1.49; 95% CI 1.10, 2.01), and CVD (HR 1.35; 95% CI 1.03, 1.78); reduced eGFR with higher risk of CVD (HR 2.09; 95% CI 1.44, 3.03), and death (HR 3.40; 95% CI 2.35, 4.92); amputation(s) with death (HR 2.97; 95% CI 1.70, 2.90); and CVD with reduced eGFR (HR 1.59; 95% CI 1.08, 2.34) and death (HR 1.95; 95% CI 1.32, 2.90). CONCLUSIONS Long-term micro- and macrovascular complications and mortality are highly correlated. Age, diabetes duration, and glycemic levels do not completely explain these associations.
Collapse
Affiliation(s)
- Ionut Bebu
- Biostatistics Center, The George Washington University, Rockville, MD
| | | | - Ian H. de Boer
- Division of Nephrology, University of Washington, Seattle, WA
| | - Lloyd P. Aiello
- Department of Ophthalmology, Joslin Diabetes Center, Boston, MA
| | - John P. Bantle
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Gayle M. Lorenzi
- Department of Medicine, University of California San Diego, La Jolla, CA
| | | | | | - Bruce A. Perkins
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Canada
| | - John M. Lachin
- Biostatistics Center, The George Washington University, Rockville, MD
| | - Mark E. Molitch
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
15
|
Battelino T, Danne T, Edelman SV, Choudhary P, Renard E, Westerbacka J, Mukherjee B, Pilorget V, Coudert M, Bergenstal RM. Continuous glucose monitoring-based time-in-range using insulin glargine 300 units/ml versus insulin degludec 100 units/ml in type 1 diabetes: The head-to-head randomized controlled InRange trial. Diabetes Obes Metab 2023; 25:545-555. [PMID: 36263928 PMCID: PMC10100006 DOI: 10.1111/dom.14898] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 02/02/2023]
Abstract
AIM To use continuous glucose monitoring (CGM)-based time-in-range (TIR) as a primary efficacy endpoint to compare the second-generation basal insulin (BI) analogues insulin glargine 300 U/ml (Gla-300) and insulin degludec 100 U/ml (IDeg-100) in adults with type 1 diabetes (T1D). MATERIALS AND METHODS InRange was a 12-week, multicentre, randomized, active-controlled, parallel-group, open-label study comparing glucose TIR and variability between Gla-300 and IDeg-100 using blinded 20-day CGM profiles. The inclusion criteria consisted of adults with T1D treated with multiple daily injections, using BI once daily and rapid-acting insulin analogues for at least 1 year, with an HbA1c of 7% or higher and of 10% or less at screening. RESULTS Overall, 343 participants were randomized: 172 received Gla-300 and 171 IDeg-100. Non-inferiority (10% relative margin) of Gla-300 versus IDeg-100 was shown for the primary endpoint (percentage TIR ≥ 70 to ≤ 180 mg/dl): least squares (LS) mean (95% confidence interval) 52.74% (51.06%, 54.42%) for Gla-300 and 55.09% (53.34%, 56.84%) for IDeg-100; LS mean difference (non-inferiority): 3.16% (0.88%, 5.44%) (non-inferiority P = .0067). Non-inferiority was shown on glucose total coefficient of variation (main secondary endpoint): LS mean 39.91% (39.20%, 40.61%) and 41.22% (40.49%, 41.95%), respectively; LS mean difference (non-inferiority) -5.44% (-6.50%, -4.38%) (non-inferiority P < .0001). Superiority of Gla-300 over IDeg-100 was not shown on TIR. Occurrences of self-measured and CGM-derived hypoglycaemia were comparable between treatment groups. Safety profiles were consistent with known profiles, with no unexpected findings. CONCLUSIONS Using clinically relevant CGM metrics, InRange shows that Gla-300 is non-inferior to IDeg-100 in people with T1D, with comparable hypoglycaemia and safety profiles.
Collapse
Affiliation(s)
- Tadej Battelino
- UMC-University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Children's and Youth Hospital "Auf Der Bult", Hannover, Germany
| | | | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | | | | | | | | | | |
Collapse
|
16
|
Helleputte S, Calders P, Rodenbach A, Marlier J, Verroken C, De Backer T, Lapauw B. Time-varying parameters of glycemic control and glycation in relation to arterial stiffness in patients with type 1 diabetes. Cardiovasc Diabetol 2022; 21:277. [PMID: 36494687 PMCID: PMC9737749 DOI: 10.1186/s12933-022-01717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A substantial proportion of type 1 diabetes (T1D) patients free from known cardiovascular disease (CVD) show premature arterial stiffening, with age, blood pressure, and HbA1c-as gold standard of glycemic control-as main predictors. However, the relationship of arterial stiffness with other time-varying parameters of glycemic control and glycation has been far less explored. This study investigated the relationship of arterial stiffness with several short- and long-term parameters of glycemic control and glycation in patients with T1D, such as advanced glycation end-products (AGEs) and continuous glucose monitoring (CGM)-derived parameters. METHODS Cross-sectional study at a tertiary care centre including 54 patients with T1D free from known CVD. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV). Current level and 10-year history of HbA1c were evaluated, and skin AGEs, urinary AGEs, and serum soluble AGE-receptor (sRAGE) concentrations. CGM for 7 days was used to determine time in range, time in hyper- and hypoglycemia, and glycemic variability. RESULTS Cf-PWV was associated with current HbA1c (rs = + 0.28), mean 10-years HbA1c (rs = + 0.36), skin AGEs (rs = + 0.40) and the skin AGEs-to-sRAGE ratio (rs = + 0.40), but not with urinary AGE or serum sRAGE concentrations; and not with any of the CGM-parameters. Multiple linear regression for cf-PWV showed that the model with the best fit included age, T1D duration, 24-h mean arterial pressure and mean 10-years HbA1c (adjusted R2 = 0.645, p < 0.001). CONCLUSIONS Longer-term glycemic exposure as reflected by current and mean 10-years HbA1c is a key predictor of arterial stiffness in patients with T1D, while no relationship was found with any of the short-term CGM parameters. Our findings stress the importance of early and sustained good glycemic control to prevent premature CVD in patients with T1D and suggest that HbA1c should continue to be used in the risk assessment for diabetic complications. The role of skin glycation, as a biomarker for vascular aging, in the risk assessment for CVD is an interesting avenue for further research.
Collapse
Affiliation(s)
- Simon Helleputte
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium ,grid.434261.60000 0000 8597 7208Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Ghent, Belgium
| | - Patrick Calders
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Arthur Rodenbach
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Joke Marlier
- grid.410566.00000 0004 0626 3303Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Verroken
- grid.410566.00000 0004 0626 3303Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium ,grid.410566.00000 0004 0626 3303Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium ,grid.410566.00000 0004 0626 3303Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
17
|
de Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH, Marcovecchio L, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes 2022; 23:1270-1276. [PMID: 36537523 PMCID: PMC10107615 DOI: 10.1111/pedi.13455] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.,Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales Medicine & Health, Sydney, Australia
| | - Tony Huynh
- Department of Endocrinology & Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Chemical Pathology, Mater Pathology, South Brisbane, Queensland, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David M Maahs
- Department of Pediatrics, Division of Endocrinology, Lucile Salter Packard Children's Hospital, Stanford University, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford University, Stanford, California, USA.,Department of Epidemiology, Stanford University, Stanford, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
18
|
Aroda VR, Eckel RH. Reconsidering the role of glycaemic control in cardiovascular disease risk in type 2 diabetes: A 21st century assessment. Diabetes Obes Metab 2022; 24:2297-2308. [PMID: 35929480 PMCID: PMC9804800 DOI: 10.1111/dom.14830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023]
Abstract
It is well known that the multiple factors contributing to the pathogenesis of type 2 diabetes (T2D) confer an increased risk of developing cardiovascular disease (CVD). Although the relationship between hyperglycaemia and increased microvascular risk is well established, the relative contribution of hyperglycaemia to macrovascular events has been strongly debated, particularly owing to the failure of attempts to reduce CVD risk through normalizing glycaemia with traditional therapies in high-risk populations. The debate has been further fuelled by the relatively recent discovery of the cardioprotective properties of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Further, as guidelines now recommend individualizing glycaemic targets, highlighting the importance of achieving glycated haemoglobin (HbA1c) goals safely, the previously observed negative influences of intensive therapy on CVD risk might not present if trials were repeated using current-day treatments and individualized HbA1c goals. Emerging longitudinal data illuminate the overall effect of excess glucose, the impacts of magnitude and duration of hyperglycaemia on disease progression and risk of CVD complications, and the importance of glycaemic control at or early after diagnosis of T2D for prevention of complications. Herein, we review the role of glucose as a modifiable cardiovascular (CV) risk factor, the role of microvascular disease in predicting macrovascular risk, and the deleterious impact of therapeutic inertia on CVD risk. We reconcile new and old data to offer a current perspective, highlighting the importance of effective, early treatment in reducing latent CV risk, and the timely use of appropriate therapy individualized to each patient's needs.
Collapse
Affiliation(s)
- Vanita R. Aroda
- Division of Endocrinology, Diabetes, and HypertensionBrigham and Women's HospitalBostonMassachusetts
| | - Robert H. Eckel
- Division of Endocrinology, Metabolism, and Diabetes, and the Division of CardiologyUniversity of Colorado School of MedicineAuroraColorado
| |
Collapse
|
19
|
Choudhary P, Kolassa R, Keuthage W, Kroeger J, Thivolet C, Evans M, Ré R, de Portu S, Vorrink L, Shin J, Habteab A, Castañeda J, da Silva J, Cohen O. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): a randomised controlled study. Lancet Diabetes Endocrinol 2022; 10:720-731. [PMID: 36058207 DOI: 10.1016/s2213-8587(22)00212-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults with type 1 diabetes who are treated with multiple daily injections of insulin plus intermittently scanned continuous glucose monitoring (isCGM) can have suboptimal glucose control. We aimed to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with such therapy in this population. METHODS The Advanced Hybrid Closed Loop Study in Adult Population with Type 1 Diabetes (ADAPT) trial is a prospective, multicentre, open-label, randomised controlled trial that involved 14 centres in three European countries (France, Germany, and the UK). We enrolled patients who were at least 18 years of age, had a type 1 diabetes duration of at least 2 years, HbA1c of at least 8% (64 mmol/mol), and were using multiple daily injections of insulin plus isCGM (cohort A) or real time continuous glucose monitoring (cohort B) for at least 3 months. Here, only results for cohort A are reported. Participants were randomly allocated 1:1 to AHCL therapy or continuation of multiple daily injections of insulin plus continuous glucose monitoring for 6 months with an investigator-blinded block randomisation procedure. Participants and treating clinicians could not be masked to the arm assignment. The primary endpoint was the between-group difference in mean HbA1c change from baseline to 6 months in the intention-to-treat population using AHCL therapy and those using multiple daily injections of insulin plus isCGM. The primary endpoint was analysed using a repeated measures random-effects model with the study arm and period as factors. Safety endpoints included the number of device deficiencies, severe hypoglycaemic events, diabetic ketoacidosis, and serious adverse events. This study is registered with ClinicalTrials.gov, NCT04235504. FINDINGS Between July 13, 2020, and March 12, 2021, 105 people were screened and 82 randomly assigned to treatment (41 in each arm). At 6 months, mean HbA1c had decreased by 1·54% (SD 0·73), from 9·00% to 7·32% in the AHCL group and 0·20% (0·80) in the multiple daily injections of insulin plus isCGM from 9·07% to 8·91% (model-based difference -1·42%, 95% CI -1·74 to -1·10; p<0·0001). No diabetic ketoacidosis, severe hypoglycaemia, or serious adverse events related to study devices occurred in either group; two severe hypoglycaemic events occurred in the run-in phase. 15 device-related non-serious adverse events occurred in the AHCL group, compared with three in the multiple daily injections of insulin plus isCGM group. Two serious adverse events occurred (one in each group), these were breast cancer (in one patient in the AHCL group) and intravitreous haemorrhage (in one patient in the multiple daily injections of insulin plus isCGM group). INTERPRETATION In people with type 1 diabetes using multiple daily injections of insulin plus isCGM and with HbA1c of at least 8%, the use of AHCL confers benefits in terms of glycaemic control beyond those that can be achieved with multiple daily injections of insulin plus isCGM. These data support wider access to AHCL in people with type 1 diabetes not at target glucose levels. FUNDING Medtronic International Trading Sàrl.
Collapse
Affiliation(s)
- Pratik Choudhary
- Kings College Hospital NHS Foundation Trust, London, UK; Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Ralf Kolassa
- Diabetologische Schwerpunktpraxis, Bergheim, Germany
| | - Winfried Keuthage
- Schwerpunktpraxis für Diabetes und Ernährungsmedizin, Münster, Germany
| | - Jens Kroeger
- Zentrum für Diabetologie Bergedorf, Hamburg, Germany
| | | | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Roseline Ré
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Simona de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Linda Vorrink
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - John Shin
- Medtronic, Northridge, California, USA
| | - Aklilu Habteab
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | | | - Julien da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
| | | |
Collapse
|
20
|
Boughton CK, Allen JM, Ware J, Wilinska ME, Hartnell S, Thankamony A, Randell T, Ghatak A, Besser REJ, Elleri D, Trevelyan N, Campbell FM, Sibayan J, Calhoun P, Bailey R, Dunseath G, Hovorka R. Closed-Loop Therapy and Preservation of C-Peptide Secretion in Type 1 Diabetes. N Engl J Med 2022; 387:882-893. [PMID: 36069870 DOI: 10.1056/nejmoa2203496] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether improved glucose control with hybrid closed-loop therapy can preserve C-peptide secretion as compared with standard insulin therapy in persons with new-onset type 1 diabetes is unclear. METHODS In a multicenter, open-label, parallel-group, randomized trial, we assigned youths 10.0 to 16.9 years of age within 21 days after a diagnosis of type 1 diabetes to receive hybrid closed-loop therapy or standard insulin therapy (control) for 24 months. The primary end point was the area under the curve (AUC) for the plasma C-peptide level (after a mixed-meal tolerance test) at 12 months after diagnosis. The analysis was performed on an intention-to-treat basis. RESULTS A total of 97 participants (mean [±SD] age, 12±2 years) underwent randomization: 51 were assigned to receive closed-loop therapy and 46 to receive control therapy. The AUC for the C-peptide level at 12 months (primary end point) did not differ significantly between the two groups (geometric mean, 0.35 pmol per milliliter [interquartile range, 0.16 to 0.49] with closed-loop therapy and 0.46 pmol per milliliter [interquartile range, 0.22 to 0.69] with control therapy; mean adjusted difference, -0.06 pmol per milliliter [95% confidence interval {CI}, -0.14 to 0.03]). There was not a substantial between-group difference in the AUC for the C-peptide level at 24 months (geometric mean, 0.18 pmol per milliliter [interquartile range, 0.06 to 0.22] with closed-loop therapy and 0.24 pmol per milliliter [interquartile range, 0.05 to 0.30] with control therapy; mean adjusted difference, -0.04 pmol per milliliter [95% CI, -0.14 to 0.06]). The arithmetic mean glycated hemoglobin level was lower in the closed-loop group than in the control group by 4 mmol per mole (0.4 percentage points; 95% CI, 0 to 8 mmol per mole [0.0 to 0.7 percentage points]) at 12 months and by 11 mmol per mole (1.0 percentage points; 95% CI, 7 to 15 mmol per mole [0.5 to 1.5 percentage points]) at 24 months. Five cases of severe hypoglycemia occurred in the closed-loop group (in 3 participants), and one occurred in the control group; one case of diabetic ketoacidosis occurred in the closed-loop group. CONCLUSIONS In youths with new-onset type 1 diabetes, intensive glucose control for 24 months did not appear to prevent the decline in residual C-peptide secretion. (Funded by the National Institute for Health and Care Research and others; CLOuD ClinicalTrials.gov number, NCT02871089.).
Collapse
Affiliation(s)
- Charlotte K Boughton
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Janet M Allen
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Julia Ware
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Malgorzata E Wilinska
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Sara Hartnell
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Ajay Thankamony
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Tabitha Randell
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Atrayee Ghatak
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Rachel E J Besser
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Daniela Elleri
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Nicola Trevelyan
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Fiona M Campbell
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Judy Sibayan
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Peter Calhoun
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Ryan Bailey
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Gareth Dunseath
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| | - Roman Hovorka
- From the Wellcome-Medical Research Council Institute of Metabolic Science (C.K.B., J.M.A., J.W., M.E.W., R.H.) and the Department of Paediatrics (J.M.A., J.W., M.E.W., A.T., R.H.), University of Cambridge, and Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust (C.K.B., S.H.), Cambridge, the Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham (T.R.), the Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool (A.G.), the Department of Paediatrics, University of Oxford, and the National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford (R.E.J.B.), the Department of Diabetes, Royal Hospital for Sick Children, Edinburgh (D.E.), the Department of Paediatric Diabetes, Southampton Children's Hospital, Southampton (N.T.), the Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds (F.M.C.), and the Diabetes Research Group, Swansea University, Swansea (G.D.) - all in the United Kingdom; and Jaeb Center for Health Research, Tampa, FL (J.S., P.C., R.B.)
| |
Collapse
|
21
|
Varkevisser RDM, Birnie E, Vollenbrock CE, Mul D, van Dijk PR, van der Klauw MM, Veeze H, Wolffenbuttel BHR, Aanstoot HJ. Cardiovascular risk management in people with type 1 diabetes: performance using three guidelines. BMJ Open Diabetes Res Care 2022; 10:10/4/e002765. [PMID: 35858715 PMCID: PMC9305824 DOI: 10.1136/bmjdrc-2022-002765] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/07/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of mortality in individuals with type 1 diabetes mellitus (T1DM). Cardiovascular risk management is therefore essential in the management of individuals with T1DM. This study describes the performance of lipid and blood pressure management in individuals with T1DM using three guidelines. RESEARCH DESIGN AND METHODS Individuals ≥18 years with T1DM, treated with insulin for ≥1 year, visiting Diabeter or the University Medical Center Groningen between January 1, 2018 and December 31, 2018, were included. Lipid and blood pressure management were examined using the Dutch, American Diabetes Association (ADA) and National Institute for Health and Care Excellence (NICE) guidelines. Concordance of recommended and prescribed lipid-lowering (LLM) or antihypertensive medication (AHM) was assessed per guideline and 10-year age groups. Achievement of treatment targets was assessed for those prescribed medication. RESULTS A total of 1855 individuals with T1DM were included. LLM and AHM was prescribed in 19% and 17%, respectively. In individuals recommended LLM, this was prescribed in 22%-46% according to Dutch, ADA or NICE guideline recommendations. For individuals recommended AHM, this was prescribed in 52%-75%. Recommended and actual prescription of LLM and AHM increased over age for all three guidelines. However, discordance between treatment recommendation and medication prescribed was higher in younger, compared with older, age groups. Low-density lipoprotein-cholesterol targets were achieved by 50% (without CVD) and 31% (with CVD) of those prescribed LLM. The blood pressure target was achieved by 46% of those prescribed AHM. CONCLUSION This study suggests that there is undertreatment of lipid and blood pressure according to guideline recommendations, particularly in younger age groups. Treatment targets are not met by most individuals prescribed medication, while guidelines recommendations differ considerably. We recommend to investigate the factors influencing undertreatment of lipid and blood pressure management in individuals with T1DM.
Collapse
Affiliation(s)
| | - Erwin Birnie
- Diabeter, Center for Focussed Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Charlotte E Vollenbrock
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Dick Mul
- Diabeter, Center for Focussed Diabetes Care and Research, Rotterdam, The Netherlands
| | - Peter R van Dijk
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie M van der Klauw
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Veeze
- Diabeter, Center for Focussed Diabetes Care and Research, Rotterdam, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, Center for Focussed Diabetes Care and Research, Rotterdam, The Netherlands
| |
Collapse
|
22
|
Moshage Y, Rodrigues F, White M, Cameron F. A pragmatic real-world trial examining the impact of an alteration of prescribing practice at diagnosis in paediatric type 1 diabetes mellitus. Diabet Med 2022; 39:e14849. [PMID: 35426172 DOI: 10.1111/dme.14849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Y Moshage
- Department of Medicine, University of Groningen, Groningen, Netherlands
- Diabetes Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Farrah Rodrigues
- Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Mary White
- Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Fergus Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
23
|
Quinn LM, Thayakaran R, Thomas N, Nirantharakumar K, Narendran P. Comment on Lachin et al. The Beneficial Effects of Earlier Versus Later Implementation of Intensive Therapy in Type 1 Diabetes. Diabetes Care 2021;44:2225-2230. Diabetes Care 2022; 45:e70-e71. [PMID: 35245356 PMCID: PMC8918199 DOI: 10.2337/dc21-2372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lauren M. Quinn
- Institute of Immunology and Immunotherapy, Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
| | - Rasiah Thayakaran
- Public Health, Epidemiology, and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
| | - Neil Thomas
- Public Health, Epidemiology, and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
| | - Krishnarajah Nirantharakumar
- Public Health, Epidemiology, and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
- Department of Diabetes, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, U.K
| |
Collapse
|
24
|
Charles MA, Leslie RD. Diabetes: Concepts of β-Cell Organ Dysfunction and Failure Would Lead to Earlier Diagnoses and Prevention. Diabetes 2021; 70:2444-2456. [PMID: 34711669 PMCID: PMC8564410 DOI: 10.2337/dbi21-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022]
Abstract
As the world endures a viral pandemic superimposed on a diabetes pandemic, the latter incorporates most of the comorbidities associated with the former, thereby exacerbating risk of death in both. An essential approach to both pandemics is prevention and unrealized earlier treatment. Thus, in this Perspective relating to diabetes, we emphasize a paradigm of, first, reversible β-cell organ dysfunction and then irreversible β-cell organ failure, which directly indicate the potential for earlier prevention, also unrealized in current guidelines. Four pillars support this paradigm: epidemiology, pathophysiology, molecular pathology, and genetics. A substantial worldwide knowledge base defines each pillar and informs a more aggressive preventive approach to most forms of the disorder. This analysis seeks to clarify the temporal and therapeutic relationships between lost β-cell function and content, illuminating the potential for earlier diagnoses and, thus, prevention. We also propose that myriad pathways leading to most forms of diabetes converge at the endoplasmic reticulum, where stress can result in β-cell death and content loss. Finally, genetic and nongenetic origins common to major types of diabetes can inform earlier diagnosis and, potentially, prevention, with the aim of preserving β-cell mass.
Collapse
|
25
|
Riddle MC, Gerstein HC, Home PD. Lingering Effects of Hyperglycemia in Recently Diagnosed Diabetes During Long-term Follow-up of the DCCT/EDIC and UKPDS Cohorts: More Evidence That Early Control Matters. Diabetes Care 2021; 44:dci210030. [PMID: 34548282 DOI: 10.2337/dci21-0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Philip D Home
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
| |
Collapse
|