Efficacy of automated insulin delivery (AID) systems in type 1 diabetes: protocol of a systematic review and network meta-analysis of outpatient randomised controlled trials

INTRODUCTION

Automated insulin delivery (AID), also known as artificial pancreas system or 'closed-loop system', represents a novel option for current treatments for type 1 diabetes (T1D). The objective of this systematic review and meta-analysis is to assess the efficacy of AID systems in comparison with current intensified insulin therapy for glycaemic control and patient-reported outcomes in individuals with T1D.

METHODS AND ANALYSIS

Studies will be eligible if they are randomised controlled trials (RCTs) in people with T1D of all ages, and if they compare an AID system for self-administration during the day and night period with any other type of insulin therapy for at least 3 weeks. The primary outcome will be time in the glucose target range of 70-180 mg/dL. A systematic review will be conducted in the MEDLINE, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov registries from their inception dates. Two authors will independently screen all references based on titles and abstracts against the eligibility criteria. For data extraction, standard forms will be developed and tested before extraction. All information will be assessed independently by at least two reviewers. The risk of bias of the included studies will be assessed using the Cochrane Risk of Bias 2 tool. The data synthesis will include a random-effects pairwise and network meta-analysis (NMA) in a frequentist framework. Where applicable and if sufficient RCTs are available, sensitivity analyses will be performed, and heterogeneity and publication bias will be assessed. The certainty of evidence from the NMA will be evaluated following the Grading of Recommendations Assessment, Development, and Evaluation working group guidance.

ETHICS AND DISSEMINATION

No ethical approval is needed. The results will be reported to the funder, presented in a peer-reviewed scientific journal and at conferences, and disseminated via press release, social media and public events.

PROSPERO REGISTRATION NUMBER

CRD42023395492.

Diabetes-related research priorities of people with type 1 and type 2 diabetes: a cross-sectional study in Germany

To investigate (i) the importance and priorities of research objectives for people with type 1 (T1DM) and type 2 diabetes (T2DM); (ii) subgroups with specific research priorities; (iii) associated factors (e.g., sociodemographic characteristics) of the subgroups. The cross-sectional survey was conducted in 2018 using data from 869 respondents (29.0% response, 31.2% female, mean age 61.3 years, 62.7% T2DM) from a German statutory health insurance population. Diabetes-related research priorities were assessed with a questionnaire. Subgroups and associated factors were identified using latent class analysis. Three subgroups were found in T1DM: (1) high priority for the research topic 'healing diabetes' and moderate priority for the research topic 'prevention of long-term complications', (2) priorities for simplifying handling (high) and stress reduction (moderate), (3) priorities for healing diabetes (high) and simplifying handling (high). Three subgroups were found in T2DM: (1) priorities for simplifying handling (moderate), diabetes prevention (moderate) and prevention of long-term complications (moderate), (2) priorities for stress reduction (high) and diabetes prevention (moderate), (3) priorities for simplifying handling (high) and stress reduction (high). Classes differed in age and HbA_1c. Knowledge about research priorities enables researchers to align their work with the needs of people with diabetes.

Associations Between Migration Background and Media and Information Behavior in Primary School Children

BACKGROUND

Children with migration background and from low socio-economic status are at higher risk for overweight. To determine appropriate media channels to possibly reach children with targeted health information, it has to be considered that the media and information behavior of children has changed during the last decades.

OBJECTIVE

We examined the media and information behavior of children in low socio-economic districts, focusing on those with migration background.

METHODS

Fourteen 3^rd grade classes (n=250 children, 68.0% with migration background) completed a questionnaire regarding their media consumption, which was based on existing validated surveys.

RESULTS

≥ 50% of the children watched TV and around 40% used both mobile phones and computers/tablets/internet for ≥1 h/day. Books were the most popular analogue media (61.6% of children), whereas magazines/newspapers and radio (18.4 and 16.0% of children, respectively) were used less frequently. Furthermore, they regularly used internet, TV and their teachers (63.0, 48.8 and 44.8% of children, respectively) as information source. Especially children with compared to those without migration background less likely used the radio (P=0.0002) and their family as information source (P=0.0017).

CONCLUSIONS

Children attending 3^rd grade class, especially with migration background, can be addressed through digital media rather than the radio. This may help to sustainably support children outside school with targeted health information.

Welche Präferenzen haben Menschen mit Diabetes mellitus in Bezug auf die Diabetesforschung? – Eine qualitative Studie

Einleitung Die Einbeziehung von Patientinnen und Patienten ist für die Entwicklung von Forschungsfragen und -vorhaben wesentlich. Bislang existieren nur wenige Informationen über die Wünsche und Präferenzen von Betroffenen bezüglich der Diabetesforschung.

Methoden Mit 26 Erwachsenen (17 Frauen) mit Typ-1-Diabetes mellitus (n = 16) oder Typ-2-Diabetes mellitus (n = 10) (Durchschnittsalter 59 Jahre ± 12,5 Jahre, durchschnittliche Diabetesdauer 21 ± 17,7 Jahre) aus Nordrhein-Westfalen (NRW) wurden 5 moderierte Fokusgruppen durchgeführt und digital audiodokumentiert. 4 Gruppen fanden im städtischen, eine Gruppe fand im ländlichen Raum statt. Die Transkripte wurden in einem multidisziplinären Team inhaltsanalytisch ausgewertet.

Ergebnisse Der Wunsch nach Entlastung im Alltag und nach Unabhängigkeit von Ernährung und Equipment wurde in allen Fokusgruppen thematisiert. Forschung zu technischen Geräten, selbstdenkenden Systemen und Messverfahren, die Blutglukosewerte einfach und jederzeit verlässlich liefern, wurde häufig angeregt. Forschung zu Therapieansätzen wurde in den Bereichen künstliche Bauchspeicheldrüse, medikamentöse Stabilisierung der Blutglukosewerte und Insulinapplikation ohne Spritze vorgeschlagen. Forschungen auf den Gebieten Zugänglichkeit von verständlichem Wissen und Prävention von Diabetes waren ebenso häufig genannte Themen. Verbesserung der Selbstmanagementfähigkeiten sowie Verhinderung von Folgeerkrankungen und auch Grundlagenforschung wurden seltener angesprochen.

Diskussion Betroffene haben – sichtbar an der Alltagsbetonung in den genannten Forschungsbereichen – eher kurzfristig umsetzbare Problemlösungen im Blick. Um die Nennung der Forschungsziele zu quantifizieren, bilden die Ergebnisse dieser Studie die Grundlage für die Entwicklung eines Fragebogens, der für eine repräsentative Befragung eingesetzt werden soll. Menschen mit Diabetes mellitus kann so die Möglichkeit gegeben werden, die aktuelle Forschung dahin gehend zu beeinflussen, dass diese sich gezielter auch an den Bedürfnissen der Betroffenen orientiert.

Positive Effects of Practical Nutrition Lessons in a Primary School Setting with a High Proportion of Migrant School Children

BACKGROUND

Children with migration background are at increased risk for overweight, partly due to less favorable dietary habits compared to their German counterparts. We examined the effects of practical nutrition lessons among children with a high proportion of migration background in a primary school setting.

METHODS

Ten 3^rd and 4^th grade classes (n=166 children, 73% with migration background) received the intervention and nine school classes (n=139 children, 76% with migration background) served as control. Before, shortly after (only among the intervention group) and three months after the three-day practical nutrition lessons, the nutrition-related skills, behavior, attitudes, and knowledge of the children were assessed using a questionnaire. Changes between baseline and 1^st follow-up among children of the intervention group were calculated using linear mixed models. Differences between the two groups for changes between baseline and 2^nd follow-up were tested using linear regression analyses. Models were adjusted for potential confounders.

RESULTS

Shortly after the practical nutrition lessons, the children of the intervention group had improved their knowledge (β=1.7; 95% CI: 1.0; 2.4, P<0.001) and skills (β=1.8; 95% CI: 1.4; 2.2, P<0.001). These changes were sustainable and larger in the intervention compared to the control group (knowledge: β=1.6; 95% CI: 0.7; 2.5, P<0.001; skills: β=1.3; 95% CI: 0.7; 1.9, P<0.001). Changes in nutrition-related behavior and attitudes did not differ between the groups.

CONCLUSIONS

Providing practical nutrition lessons in a primary school setting with a high proportion of children with immigrational background improved the children's nutrition-related knowledge and skills.

Positive Effects of Promoting Physical Activity and Balanced Diets in a Primary School Setting with a High Proportion of Migrant School Children

Background Children with migration background are at particular risk for overweight. We assessed the effects of a primary school-based initiative targeted at enhancing physical activity and dietary education among children with a high proportion of migration background. Methods Four 3rd and 4th grade classes (n=70 children, 77% with migration background) participated in a 10-months intervention comprising 2 additional exercise lessons weekly and 10 nutrition lessons per school year. 6 school classes (n=125 children, 65% with migration background) served as control. Before and after the intervention, an assessment of physical fitness and motor skills and questionnaires on dietary behavior and knowledge were conducted. In a subgroup (n=37), after 6 months of the intervention, daily physical activity was assessed by accelerometer-based monitoring. Differences in changes between the groups were assessed using linear regression analyses. Results Changes between the 2 time points for fitness and motor skill tests (differences in standard deviation scores) were larger in the intervention than in the control group for the total mean test value (β=0.38, p<0.001), driven by higher improvements in 5 of the 8 test items, i.e., obstacle race (speed) (β=0.22, p=0.049), standing long jump (strength) (β=0.35, p<0.001), sit-ups (strength) (β=0.33, p=0.002), stand and reach (mobility) (β=0.22, p=0.042), and 6 min run (endurance) (β=0.40, p<0.001), independently of confounders. Changes in dietary knowledge and consumption frequencies did not differ between groups. Conclusions Promoting guided physical activity in a primary school setting with a high proportion of children with migration background positively affected parameters of fitness and motor skills.

Oligodendrocytes expressing exclusively the DM20 isoform of the proteolipid protein gene: myelination and development

Oligodendroglia and Schwann cells synthesize myelin-specific proteins and lipids for the assembly of the highly organized myelin membrane of the motor-sensory axons in the central (CNS) and peripheral nervous system (PNS), respectively, allowing rapid saltatory conduction. The isoforms of the main myelin proteins, the peripheral myelin basic isoproteins (MBP) and the integral proteolipid proteins, PLP and DM20, arise from alternative splicing. Activation of a cryptic splice site in exon III of plp leads to the deletion of 105 bp encoding the PLP-specific 35 amino acid residues within the cytosolic loop 3 of the four-transmembrane domain (TMD) integral membrane protein. To study the different proposed functions of DM20 during the development of oligodendrocytes and in myelination, we targeted the plp locus in embryonic stem cells by homologous recombination by a construct, which allows solely the expression of the DM20 specific exon III sequence. The resulting dm20(only) mouse line expresses exclusively DM20 isoprotein, which is functionally assembled into the membrane, forming a highly ordered and tightly compacted myelin sheath. The truncated cytosolic loop devoid of the PLP-specific 35 amino acid residues, including two thioester groups, had no impact on the periodicity of CNS myelin. In contrast to the PLP/DM20-deficient mouse, mutant CNS of dm20(only) mice showed no axonal swellings and neurodegeneration but a slow punctuated disintegration of the compact layers of the myelin sheath and a rare oligodendrocyte death developing with aging.

Rumpshaker-like proteolipid protein (PLP) ratio in a mouse model with unperturbed structural and functional integrity of the myelin sheath and axons in the central nervous system

The gene plp on the X chromosome encodes the isoforms proteolipid protein (PLP) and DM(20), two dominant integral membrane proteins of central nervous system (CNS) myelin. DM(20) results from the activation of the cryptic splice site in exon III of the PLP gene. We inserted a sense-orientated loxP flanked neomycin-gene into intron III of the plp sequence, using homologous recombination in embryonic stem cells and generated the homozygous neoS mouse line. Unlike the previously described complete PLP/DM(20) ablation (plp(-/-)), which has been obtained by introducing a neo-gene in antisense-orientation in the same position of intron III, the plp expression surprisingly revealed reduced mRNA levels. The PLP isoform was reduced to 50%, but DM(20) expression was unaffected. This protein pattern resembles the expression profile of the PLP isoforms in the natural occurring rumpshaker mutant. Electron microscopic examination revealed a normal compaction of CNS-myelin and maintenance of axon integrity. PLP expression levels of the wt control were recovered by Cre excision of the neo-selection gene after intercrossing neoS mice and oligodendrocyte-specific Cre-mice. These data strongly hint at different functions of intron III in PLP/DM(20)-specific splicing and mRNA stability. Furthermore evidence is provided for functionally affected translation products of the PLP gene in the rumpshaker mutant, whereas no PLP-isoform occur in plp(-/-) mice generated by introducing a selectable marker into intron III in antisense orientation.