Measurement of glycated hemoglobin (HbA
) has been the traditional method for assessing glycemic control. However, it does not reflect intra- and interday glycemic excursions that may lead to acute ...events (such as hypoglycemia) or postprandial hyperglycemia, which have been linked to both microvascular and macrovascular complications. Continuous glucose monitoring (CGM), either from real-time use (rtCGM) or intermittently viewed (iCGM), addresses many of the limitations inherent in HbA
testing and self-monitoring of blood glucose. Although both provide the means to move beyond the HbA
measurement as the sole marker of glycemic control, standardized metrics for analyzing CGM data are lacking. Moreover, clear criteria for matching people with diabetes to the most appropriate glucose monitoring methodologies, as well as standardized advice about how best to use the new information they provide, have yet to be established. In February 2017, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address these issues. This article summarizes the ATTD consensus recommendations and represents the current understanding of how CGM results can affect outcomes.
This randomized, crossover trial compared an artificial-pancreas system with a sensor-augmented pump for nocturnal glucose control in young persons with type 1 diabetes at a diabetes camp. The ...artificial pancreas resulted in less hypoglycemia and tighter glucose control.
Intensive insulin therapy is considered to be the standard treatment for tight blood glucose control in patients with type 1 diabetes, since it prevents long-term complications. Several studies have promoted the use of insulin pumps, glucose sensors, or a combination of the two devices (sensor-augmented pump)
1
–
3
to improve glucose control. However, the risk of hypoglycemia is still present with the use of all currently available therapies.
4
–
6
Maintenance of nocturnal euglycemia is extremely important and is challenging, since most cases of severe hypoglycemia occur at night.
7
,
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Such episodes account for 75% of total hypoglycemic seizures in children
9
and . . .
Smartphone technologies, and the applications (apps) that they host, are developing rapidly mainly with regard to communication, information processing, design, features and connectivity with other ...devices. Technologies used in modern treatment modalities and monitoring of type 1 diabetes are also rapidly evolving and can communicate with smartphones and apps. Therefore, numerous web-based and smartphone apps aim to provide information and various patient data metrics (e.g. caloric intake, activity levels, glucose monitoring) that can be accessed and processed for decision support by smartphone apps. In this narrative review, we highlight current information about the effectiveness of interventions through smartphone apps with a focus on apps designed to give guidance to patients with type 1 diabetes on physical activity monitoring and glucose control during and after structured exercise sessions, as these patients are experiencing huge therapeutic challenges during exercise. Furthermore, we propose a number of critical elements for future apps designed for people with type 1 diabetes.
Use of sodium glucose cotransporter (SGLT) inhibitors are a well‐established therapeutic option in type 2 diabetes (T2D) with a variety of proven therapeutic benefits. They have become a pillar of ...current treatment guidelines. In type 1 diabetes (T1D), initial exploratory studies have shown benefits in glycemic control, weight control, and cardiovascular risk parameters, leading to trials aiming for regulatory submission with several agents. Results from four 1‐year trials, which included a total of 3052 patients, are now available, demonstrating promising findings that target the unmet needs of patients with T1D with a novel insulin‐independent adjunct therapy. However, these positive effects must be balanced against the risks associated with this class of drugs. Specifically, current T1D studies have shown an increased risk of diabetic ketoacidosis (DKA), which, in some cases, presented with only slightly elevated glucose levels. While this complication may be clinically manageable once detected, the metabolic shift towards ketogenesis associated with this class of agents mandates appropriate patient selection. Currently, there are no validated tools for DKA risk assessment. Although the experience gained in studies and off‐label use provides some indication for appropriate patient selection, this would have to be evaluated closely in the event that these drugs would receive regulatory approval. Risk mitigation includes training in ketone measurement (preferably as blood β‐hydroxybutyrate testing), teaching the concept of euglycemic DKA, and providing a clear treatment algorithm to avoid progression of ketosis to full‐blown DKA. Because similar unmet needs also exist in pediatric population studies, risk mitigation in youth should be initiated as well to allow an evidence‐based, risk‐benefit assessment in this vulnerable population.
This trial assessed alum-formulated glutamic acid decarboxylase, the 65-kD isoform (GAD65), a major autoantigen in type 1 diabetes. In patients with recent-onset disease; the compound did not ...significantly alter the loss of C peptide or improve clinical outcomes.
The clinical onset of type 1 diabetes is manifested by the effects of inadequate insulin secretion due to the immunologic destruction of pancreatic-islet beta cells.
1
Despite replacement therapy with exogenous insulin, type 1 diabetes is associated with substantial morbidity and mortality.
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,
3
Even modest preservation of insulin secretion appears to reduce short- and long-term complications of type 1 diabetes.
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Initial attempts at immunosuppression to treat type 1 diabetes had a positive effect but one that was outweighed by treatment-related adverse events.
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More recently, selective immunosuppression has been attempted. Phase 2 trials showed promising efficacy, but phase 3 studies . . .
Objectives To investigate the safety, tolerability, and pharmacokinetics of liraglutide in adolescents with obesity. Study design This was a randomized, double-blind, placebo-controlled trial. ...Twenty-one subjects, aged 12-17 years and Tanner stage 2-5, with obesity (body mass index BMI corresponding to both a BMI ≥95th percentile for age and sex and to a BMI of ≥30 kg/m2 for adults; additionally, BMI was ≤45 kg/m2 ) were randomized (2:1) to receive 5 weeks of treatment with liraglutide (0.6 mg with weekly dose increase to a maximum of 3.0 mg for the last week) (n = 14) or placebo (n = 7). The primary endpoint was number of treatment-emergent adverse events (TEAEs). Secondary endpoints included safety measures, and pharmacokinetic and pharmacodynamic endpoints. Results All participants receiving liraglutide, and 4 receiving placebo (57.1%), had at least 1 TEAE. The most common TEAEs were gastrointestinal disorders. No severe TEAEs, TEAE-related withdrawals, or deaths occurred. Twelve hypoglycemic episodes occurred in 8 participants receiving liraglutide and 2 in 1 participant receiving placebo. No severe hypoglycemic episodes were reported. Liraglutide exposure in terms of trough concentration increased with dose, although dose proportionality was confounded by unexpectedly low trough concentration values at the 2.4 mg dose. Exposure in terms of model-derived area under the plasma concentration time curve from 0 to 24 hours after dose in steady state was similar to that in adults with obesity. Conclusions Liraglutide had a similar safety and tolerability profile compared with adults when administered to adolescents with obesity, with no unexpected safety/tolerability issues. Results suggest that the dosing regimen approved for weight management in adults may be appropriate for use in adolescents. Trial registration ClinicalTrials.gov : NCT01789086.
For paediatric patients with type 1 diabetes, intensified insulin therapy with either multiple daily injection or insulin pump therapy is currently the only method of treatment. To optimize this ...therapy, insulin analogues are fixed parts of all therapy regimens. New ultra-rapid insulins seem to be beneficial not only in adults but also in this age group. New developments in long-acting analogues have demonstrated safety and will be regular in paediatrics, we hope, soon. Furthermore, the psychosocial approach for consideration of real-life aspects becomes more the focus of therapeutic regimens and is implemented into international guidelines. Technical improvements, such as continuous glucose monitoring, particularly in combination with pump therapy, support the great success of rapid-acting analogues by reducing hypoglycaemias. Non-insulin agents such as SGLT2-inhibitors show beneficial aspects in people with type 1 diabetes. For outpatient care with these currently off-label-used drugs, special training for measurement of ketones should be imperative.
The etiology of type 1 diabetes has polygenic and environmental determinants that lead to autoimmune responses against pancreatic β cells and promote β cell death. The autoimmunity is considered ...silent without metabolic consequences until late preclinical stages,and it remains unknown how early in the disease process the pancreatic β cell is compromised. To address this, we investigated preprandial nonfasting and postprandial blood glucose concentrations and islet autoantibody development in 1,050 children with high genetic risk of type 1 diabetes. Pre- and postprandial blood glucose decreased between 4 and 18 months of age and gradually increased until the final measurements at 3.6 years of age. Determinants of blood glucose trajectories in the first year of life included sex, body mass index, glucose-related genetic risk scores, and the type 1 diabetes-susceptible INS gene. Children who developed islet autoantibodies had early elevations in blood glucose concentrations. A sharp and sustained rise in postprandial blood glucose was observed at around 2 months prior to autoantibody seroconversion, with further increases in postprandial and, subsequently, preprandial values after seroconversion. These findings show heterogeneity in blood glucose control in infancy and early childhood and suggest that islet autoimmunity is concurrent or subsequent to insults on the pancreatic islets.
This study aimed to evaluate the impact of the COVID-19 pandemic on the nutritional patterns, eating behavior, dietary content, and health-related quality of life (HrQoL) of adolescents with ...preexisting obesity.
Anthropometric and metabolic parameters were measured, and validated questionnaires on eating habits, nutritional content, and HrQoL were administered to 264 adolescents with obesity during the COVID-19 pandemic (June 2020-June 2022) and 265 adolescents with obesity before the pandemic (from June 2017 to June 2019).
Both study cohorts were comparable in age and sex distribution. Significant differences were found between the COVID-19 and pre-COVID-19 cohorts in HOMA-index (3.8 (interquartile range IQR)): 3.3; 4.1) vs. 3.2 (IQR: 2.8; 3.5,
< 0.001), total cholesterol (208.8 mg/dL (IQR: 189.9; 214.5) vs. 198.5 mg/dL (IQR: 189.5; 207.4),
< 0.001), and GPT (93.4 (IQR 88.7; 96.5) vs. 72.8 U/L (IQR 68.9; 75.7),
< 0.001). The COVID-19 cohort reported significantly higher consumption of obesity-promoting food components, such as soft drinks, meat, sausages, fast food and delivery food, chocolate, and sweets. There was also a significant decrease in cognitive hunger control (
= 0.002) and an increase in distractibility potential (
= 0.001) while eating. HrQoL was significantly lower in the COVID-19 cohort (
= 0.001).
This study reveals the adverse associations of exposure to the public health measures during the COVID-19 pandemic with nutrition, dietary content, and HrQoL in adolescents with preexisting obesity. These findings underscore the importance of tailored preventive and treatment strategies for addressing the specific challenges of disruptive events such as pandemics, especially in population-based context.
Spectrum and Prevalence of Atherogenic Risk Factors in 27,358 Children, Adolescents, and Young Adults With Type 1 Diabetes
Cross-sectional data from the German diabetes documentation and quality ...management system (DPV)
K. Otfried Schwab , MD 1 ,
Jürgen Doerfer , MD 1 ,
Wolfgang Hecker , MD 2 ,
Jürgen Grulich-Henn , MD 3 ,
Dagobert Wiemann , MD 4 ,
Olga Kordonouri , MD 5 ,
Peter Beyer , MD 6 ,
Reinhard W. Holl , MD 7 and
on behalf of the DPV Initiative of the German Working Group for Pediatric Diabetology
1 Department of Pediatrics and Adolescence Medicine, Freiburg University Hospital, Freiburg, Germany
2 Olgahospital, Children’s Hospital, Stuttgart, Germany
3 Department of Pediatrics, Heidelberg University Hospital, Heidelberg, Germany
4 Department of Pediatrics, Magdeburg University Hospital, Magdeburg, Germany
5 Otto-Heubner Center of Pediatrics and Adolescents Medicine, Charité, Humboldt University Hospital, Berlin Germany
6 Clinic for Pediatrics, Protestant Hospital, Oberhausen, Germany
7 Department of Epidemiology, Ulm University, Ulm, Germany
Address correspondence and reprint requests to Prof. Dr. K.O. Schwab, MD, Department of Pediatrics and Adolescence Medicine,
Freiburg University Hospital, Mathilden Str. 1, D-79106 Freiburg, Germany. E-mail: schwab{at}kikli.ukl.uni-freiburg.de
Abstract
OBJECTIVE —The aim of this data analysis was to ascertain the type and prevalence rate as well as age and sex distribution of cardiovascular
risk factors in type 1 diabetic patients up to 26 years of age.
RESEARCH DESIGN AND METHODS —Cardiovascular risk factors such as obesity, hypertension, dyslipidemia, poor glycemic control, and smoking were analyzed
in 27,358 patients who were divided into three groups (prepubertal, pubertal, and adult) using specifically designed diabetes
software for prospective disease documentation.
RESULTS —More than half of the patients per age-group had at least one cardiovascular risk factor. Two risk factors were age dependently
found in 6.2–21.7% and three or four risk factors in 0.5–4.7%. Elevated values of HbA 1c , total cholesterol, and BMI were found most frequently. Hypertension, smoking, and HDL cholesterol were observed more frequently
in males, and elevated BMI, total cholesterol, and LDL cholesterol more often in females. Although 28.6% of the patients had
dyslipidemia, merely 0.4% of them received medical treatment, and of the 8.1% of the patients with hypertension, only 2.1%
of them were given antihypertensive medication.
CONCLUSIONS —With increasing age, a greater number of patients with cardiovascular risk factors were observed. Significant sex differences
were seen in the majority of risk factors. Despite the high prevalence of risk factors, only a small minority of patients
received antihypertensive or lipid-lowering treatment. Early identification, prevention, and treatment of additional risk
factors seem to be necessary, particularly in light of the high incidence of future cardiovascular disease.
CVD, cardiovascular disease
DCCT, Diabetes Control and Complications Trial
DPV, diabetes data acquisition system for prospective surveillance
PDAY, Pathobiological Determinants of Atherosclerosis in Youth
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted October 20, 2005.
Received April 25, 2005.
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