Aim
Automated insulin delivery systems have improved glycaemic control in people with type 1 diabetes mellitus. The analysis investigated predictors of improved sensor glucose time‐in‐range (TIR; ...70‐180 mg/dl) based on real‐world use of the MiniMed 780G advanced hybrid closed‐loop (AHCL) system.
Methods
Data uploaded by MiniMed 780G system users from August 2020‐July 2021 were analysed using univariate and multivariable models to identify baseline, demographic and system use characteristics associated with TIR after AHCL initiation (post‐AHCL). System settings associated with improved TIR post‐AHCL were identified and their impact on time below range (TBR, <70 mg/dl) post‐AHCL was explored.
Results
In total, 12 870 users were included, of which 2977 had baseline sensor glucose data. Baseline TIR and time in AHCL (defined as the percentage of time the system was in Auto‐mode) were positively associated with TIR post‐AHCL with larger values predicting greater mean TIR post‐AHCL. Characteristics inversely associated with TIR post‐AHCL included the percentage of daily basal insulin dose, daily autocorrection dose, number of daily AHCL exits triggered by the system and number of daily alarms, wherein larger values of these characteristics predicted lower mean TIR post‐AHCL. System settings that predicted the largest mean TIR post‐AHCL were active insulin time of 2 h and glucose target of 100 mg/dl. Active insulin time was not associated with TBR post‐AHCL.
Conclusion
Modifiable factors, including optimized pump settings, can allow users to achieve glycaemic targets with >80% TIR. The findings from this analysis will potentially guide the optimal use of the MiniMed 780G system and facilitate meaningful improvements in safe glycaemic control.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Aims
To examine whether frequency, perceived severity and fear of hypoglycaemia are independently associated with diabetes‐specific quality of life in adolescents with type 1 diabetes.
Methods
...Cross‐sectional self‐reported data on demographics, frequency and perceived severity of both self‐treated and severe hypoglycaemia, fear of hypoglycaemia (Hypoglycaemia Fear Survey—Child version) and diabetes‐specific quality of life (Pediatric Quality of Life Diabetes Module; PedsQL‐DM) were obtained from the project ‘Whose diabetes is it anyway?’. Hierarchical regression analyses were performed for the total scale and recommended summary scores of the PedsQL‐DM as dependent variables; independent variables were entered in the following steps: (1) age, gender and HbA1c, (2) frequency of hypoglycaemia, (3) perceived severity of hypoglycaemia and (4) fear of hypoglycaemia.
Results
Adolescents (12–18 years; n = 96) completed questionnaires. In the first three steps, female gender (p < 0.05), higher HbA1c (p < 0.05), higher frequency of severe hypoglycaemia (p < 0.05) and higher perceived severity of severe (p < 0.05) and self‐treated hypoglycaemia (p < 0.001) were significantly associated with lower diabetes‐specific quality of life (β ranging from 0.20 to 0.35). However, in the final model only fear of hypoglycaemia was significantly associated with QoL (p < 0.001). Adolescents with greater fear reported lower diabetes‐specific quality of life, with 52% explained variance. This pattern was observed across subdomains of diabetes‐specific quality of life.
Conclusions
Fear of hypoglycaemia was the only factor independently associated with diabetes‐specific quality of life, whereas frequency and perceived severity of hypoglycaemia were not. These findings highlight the importance of awareness and assessment of fear of hypoglycaemia in clinical practice.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
To examine the impact of real-time continuous glucose monitoring (RT-CGM) on quality of life in Dutch adults with type 1 diabetes, inside/outside automated insulin delivery (AID) systems.
In this ...cross-sectional retrospective observational study, RT-CGM users completed an online survey including (adapted) validated questionnaires, study-specific items and open-ended questions.
Of 893 participating adults, 69% used the RT-CGM as part of AID. The overall sample reported improvements in quality of life related to RT-CGM use (irrespective of initial indication), particularly with respect to physical health, emotional wellbeing and energy. Merits for sleep, intimacy and cognitive diabetes load lagged somewhat behind, mostly when RT-CGM was not integrated in AID. Users of AID had significantly larger improvements in overall quality of life, fatigue and diabetes-specific distress than users of sensor-augmented pump or Open Loop treatment. In regression analyses, user evaluations were associated with perceptions of benefit and burden. In qualitative content analysis, benefits (e.g. life ‘normalization’, increased perceptions of control) outweighed burdens (e.g. technology frustrations, confrontation with diabetes).
RT-CGM positively impacted the quality of life of adults with type 1 diabetes. This justifies a (re-)consideration of broader access. Increased support to maximize device benefits and minimize burdens is also warranted.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Introduction
C‐peptide is an important marker to assess residual insulin production in individuals with type 1 diabetes (T1D). The accuracy and detection limits of C‐peptide assays are important to ...detect C‐peptide microsecretion and to reliably observe changes over time in these people. We compared and verified two commercially available assays able to measure C‐peptide in the picomolar range.
Methods
The ultrasensitive Mercodia enzyme‐linked immunosorbent C‐peptide assay (ELISA) was compared with the Beckman immunoradiometric assay (IRMA) for C‐peptide, assessing reproducibility (coefficient of variation CV), limit of blank (LoB), limit of detection (LoD) and limit of quantitation (LoQ).
Results
For both assays within‐run and between‐run variation were high at the low (around the detection limit) C‐peptide concentration range, with CVs of around 40%. LoB values for the ultrasensitive ELISA and the IRMA were 1.3 and 0.16 pmol/L respectively. LoD values were 2.4 and 0.54 pmol/L respectively. LoQ values were 9.7 and 3.8 pmol/L respectively. Only the IRMA met the specifications claimed by the manufacturer.
Conclusions
The IRMA provided the lowest threshold for quantification of serum C‐peptide. LoQ of commercially available assays should be established in‐house before applying them in research studies and clinical trials in which low C‐peptide levels have clinical or scientific relevance.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Aim
To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes.
Design
Qualitative ...focus group study.
Methods
Across four sites in the Netherlands, 18 parents (13 mothers) of children (9–14 years) with type 1 diabetes participated in four focus groups in 2015–2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data.
Results
According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well‐being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values.
Conclusion
How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains.
Impact
Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family‐based approach into current age‐based guidelines, to improve regular care.
摘要
目的
确定除儿童年龄外, 哪些因素可能对父母和患有1型糖尿病的儿童的糖尿病护理责任划分和转移产生影响。
设计
定性焦点小组研究。
方法
2015‐2016年间, 在荷兰境内四地展开研究, 研究对象为18名患有1型糖尿病的儿童 (9‐14岁) 的父母 (13名母亲) , 共分为四个重点小组, 此类研究作为‘谁患有糖尿病’研究项目的一部分。此外, 采用定性含量分析法和持续比较法对数据进行分析。
结果
父母表示, 转移过程中, 需执行不同难度的直接和间接任务 (记忆、决定、执行) , 部分情况下, 面临较大困难和压力, 并且, 不同家庭的差异较大。经确定, 大量儿童、父母和背景因素可能对糖尿病护理责任的划分和转移造成影响。现已对转移过程对父母和儿童健康、行为和幸福的积极和消极后果进行描述。父母对糖尿病护理责任划分和转移的最终评估取决于其价值观。
结论
家庭分配和转移糖尿病护理责任的方式似乎与儿童、父母及背景特征的复杂作用相关, 而此类作用对父母和儿童均有一定程度的影响。
影响
父母忙于确定准确的转移时间, 因此, 糖尿病护士需予以更多支持。可考虑此类已确定的因素, 以便将更多家庭方法整合至现有基于年龄的指南中, 从而改善常规护理。
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aims
This study aims to evaluate the stability of C‐peptide over time and to compare fasting C‐peptide and C‐peptide response after mixed‐meal tolerance test (MMTT) at T90 or T120 with C‐peptide area ...under the curve (AUC) in long‐standing type 1 diabetes.
Methods
We included 607 type 1 diabetes individuals with diabetes duration >5 years. C‐peptide concentrations (ultrasensitive assay) were collected in the fasting state, and in a subpopulation after MMTT (T0, just prior to, T30‐T60‐T90‐T120, 30–120 min after ingestion of mixed‐meal) (n = 168). Fasting C‐peptide concentrations (in n = 535) at Year 0 and Year 1 were compared. The clinical determinants associated with residual C‐peptide secretion and the correspondence of C‐peptide at MMTT T90 / T120 and total AUC were assessed.
Results
A total of 153 participants (25%) had detectable fasting serum C‐peptide (i.e ≥ 3.8 pmol/L). Fasting C‐peptide was significantly lower at Year 1 (p < 0.001, effect size = −0.16). Participants with higher fasting C‐peptide had a higher age at diagnosis and shorter disease duration and were less frequently insulin pump users. Overall, 109 of 168 (65%) participants had both non‐detectable fasting and post‐meal serum C‐peptide concentrations. The T90 and T120 C‐peptide values at MMTT were concordant with total AUC. In 17 (10%) individuals, C‐peptide was only detectable at MMTT and not in the fasting state.
Conclusions
Stimulated C‐peptide was detectable in an additional 10% of individuals compared with fasting in individuals with >5 years of diabetes duration. T90 and T120 MMTT measurements showed good concordance with the MMTT total AUC. Overall, there was a decrease of C‐peptide at 1‐year follow‐up.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objectives
We aim to determine the prevalence and the course of anxiety and mood disorders in Dutch adolescents (12–18 years old) with type 1 diabetes, and to examine correlates of symptom severity, ...including parental emotional distress.
Methods
Participants were 171 adolescents and 149 parents. The Diagnostic Interview Schedule for Children‐IV was used to assess current, past year and lifetime anxiety and mood disorders in adolescents. Symptom severity and diabetes distress were measured with validated questionnaires. Correlates of these symptoms were examined using hierarchical regression analyses and included demographics (adolescent sex and age), clinical factors (diabetes duration, treatment modality, most recent glycated hemoglobin A1c; all extracted from medical charts), adolescent diabetes distress, and parent emotional distress.
Results
Twenty‐four (14%) adolescents met the criteria for ≥1 disorder(s) in the previous 12 months. Anxiety disorders were more prevalent than mood disorders (13% vs. 4%). Lifetime prevalence of anxiety and mood disorders was 29% (n = 49). The presence of any of these disorders earlier in life (from 5 years old up to 12 months prior to assessment) was associated with disorders in the past 12 months (OR = 4.88, p = 0.001). Higher adolescent diabetes distress was related to higher symptoms of anxiety (b = 0.07, p = 0.001) and depression (b = 0.13, p = 0.001), while demographics, clinical characteristics, and parental emotional distress were not related.
Conclusions
Anxiety and mood disorders are common among adolescents and related to earlier disorders. Higher diabetes distress was related to higher symptom severity. Clinicians are advised to address past psychological problems and remain vigilant of these problems.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Longitudinal studies including parental distress when examining adverse health outcomes in adolescents with type 1 diabetes are lacking. This study examined whether parental depression and anxiety ...predict adolescent emotional distress and glycated hemoglobin A
(HbA
) 1 year later and whether a relation between parental distress and HbA
is mediated by the level of parental involvement in diabetes care and by treatment behaviors.
Longitudinal path modeling was applied to data from 154 adolescents and parents from diabetes centers participating in the Longitudinal study of Emotional problems in Adolescents with type 1 diabetes and their Parents/caregivers (Diabetes LEAP). At baseline and 1-year follow-up, participants completed measures of depression and anxiety. HbA
was extracted from medical charts. Responsibility and treatment behavior questionnaires were completed by adolescents at baseline.
Baseline parental depressive and anxiety symptoms were not associated with 1-year adolescent depressive symptoms, anxiety symptoms, and HbA
. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA
.
Parental depressive and anxiety symptoms did not predict adolescent health outcomes 1 year later. Future studies may determine whether the link is present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress.
Adolescents with T1D are a vulnerable group in terms of psychological and health outcomes. Whether parental emotional distress (i.e., depressive and anxiety symptoms) is prospectively associated with adolescent emotional distress and/or HbA
has been understudied. Our results show that parental distress was not related to adolescent distress or HbA
1 year later. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA
. Future studies could determine whether these links are present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Aims/hypothesis
Heterogeneity in individuals with type 1 diabetes has become more generally appreciated, but has not yet been extensively and systematically characterised. Here, we aimed to ...characterise type 1 diabetes heterogeneity by creating immunological, genetic and clinical profiles for individuals with juvenile-onset type 1 diabetes in a cross-sectional study.
Methods
Participants were HLA-genotyped to determine
HLA-DR-DQ
risk, and SNP-genotyped to generate a non-HLA genetic risk score (GRS) based on 93 type 1 diabetes-associated SNP variants outside the MHC region. Islet autoimmunity was assessed as T cell proliferation upon stimulation with the beta cell antigens GAD65, islet antigen-2 (IA-2), preproinsulin (PPI) and defective ribosomal product of the insulin gene (INS-DRIP). Clinical parameters were collected retrospectively.
Results
Of 80 individuals, 67 had proliferation responses to one or more islet antigens, with vast differences in the extent of proliferation. Based on the multitude and amplitude of the proliferation responses, individuals were clustered into non-, intermediate and high responders. High responders could not be characterised entirely by enrichment for the highest risk HLA-
DR3-DQ2/DR4-DQ8
genotype. However, high responders did have a significantly higher non-HLA GRS. Clinically, high T cell responses to beta cell antigens did not reflect in worsened glycaemic control, increased complications, development of associated autoimmunity or younger age at disease onset. The number of beta cell antigens that an individual responded to increased with disease duration, pointing to chronic islet autoimmunity and epitope spreading.
Conclusions/interpretation
Collectively, these data provide new insights into type 1 diabetes disease heterogeneity and highlight the importance of stratifying patients on the basis of their genetic and autoimmune signatures for immunotherapy and personalised disease management.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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