Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control

Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi’s method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents’ misconceptions regarding self-management of diabetes.

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Prevention of Hypoglycemia While Achieving Good Glycemic Control in Type 1 Diabetes: The role of insulin analogs

Diabetes Care ◽

10.2337/dc08-s227 ◽

2008 ◽

Vol 31 (Supplement 2) ◽

pp. S113-S120 ◽

Cited By ~ 33

Author(s):

P. Rossetti ◽

F. Porcellati ◽

G. B. Bolli ◽

C. G. Fanelli

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Insulin Analogs ◽

Good Glycemic Control

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Inflammatory Markers Are Increased in Youth with Type 1 Diabetes: The SEARCH Case-Control Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-1993 ◽

2010 ◽

Vol 95 (6) ◽

pp. 2868-2876 ◽

Cited By ~ 66

Author(s):

Janet K. Snell-Bergeon ◽

Nancy A. West ◽

Elizabeth J. Mayer-Davis ◽

Angela D. Liese ◽

Santica M. Marcovina ◽

...

Keyword(s):

Type 1 Diabetes ◽

South Carolina ◽

Glycemic Control ◽

Apolipoprotein B ◽

Inflammatory Markers ◽

Glycated Hemoglobin ◽

Case Control ◽

Good Glycemic Control ◽

Diabetes Status

Abstract Context: Increased inflammation may contribute to type 1 diabetes (T1D) complications. Objective: The objective of the study was to investigate the association of inflammation with obesity, hyperglycemia and dyslipidemia in youth with T1D. Design: This was a cross-sectional study of youth with and without T1D. Setting: The study was conducted in Colorado and South Carolina. Patients: SEARCH Case-Control participants with T1D [n = 553, mean age 15 yr (range 10–22), median duration 2.7 yr] and without diabetes [n = 215, mean age 15 yr (range 10–22)]. Intervention: This was an observational study. Main Outcome Measures: IL-6, high-sensitivity C-reactive protein (hsCRP), fibrinogen, and leptin were measured. Results: Inflammatory markers were evaluated by diabetes status, quartiles of glycated hemoglobin, and obesity using multiple linear regression analyses, adjusted for age, sex, study site, race/ethnicity, T1D duration, body mass index, and pubertal status. Compared with controls, youth with T1D had higher IL-6 and fibrinogen levels at all levels of glycemia and obesity, and hsCRP levels were significantly higher in youth with T1D in the top three quartiles of glycated hemoglobin (≥7.2%) and among normal-weight subjects. Leptin was lower in youth with poor glycemic control. Higher hsCRP and fibrinogen were correlated with higher total and LDL cholesterol, and apolipoprotein B in youth with T1D, whereas higher fibrinogen was correlated with higher LDL and apolipoprotein B in controls. Conclusions: T1D is characterized by excess inflammation, independent of adiposity and glycemic control. Even T1D youth in good glycemic control had higher levels of IL-6 and fibrinogen than controls. Elevated inflammatory markers were associated with an atherogenic lipid profile, which may contribute to accelerated atherosclerosis in youth with T1D.

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Residual β-Cell Function More than Glycemic Control Determines Abnormalities of the Insulin-Like Growth Factor System in Type 1 Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2004-0572 ◽

2004 ◽

Vol 89 (12) ◽

pp. 6305-6309 ◽

Cited By ~ 39

Author(s):

Christina A. Hedman ◽

Jan Frystyk ◽

Torbjörn Lindström ◽

Jian-Wen Chen ◽

Allan Flyvbjerg ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Cell Function ◽

Β Cell ◽

Good Glycemic Control ◽

C Peptide ◽

Igf I ◽

Β Cell Function ◽

Igfbp 3

Abstract The GH-IGF-I axis is disturbed in patients with type 1 diabetes. Our aim was to investigate whether abnormalities are found in patients in very good glycemic control and, if so, to estimate the role of residual β-cell function. Patients with hemoglobin A1c (HbA1c) less than 6% (reference range, 3.6–5.4%) were selected for the study. Twenty-two men and 24 women, aged 41.3 ± 13.8 yr (mean ± sd), with a diabetes duration of 17.8 ± 14.6 yr participated. Healthy controls (15 women and nine men), aged 41.3 ± 13.0 yr, were also studied. Overnight fasting serum samples were analyzed for HbA1c, C peptide, free and total IGFs, IGF-binding proteins (IGFBPs), GH-binding protein, and IGFBP-3 proteolysis. HbA1c was 5.6 ± 0.5% in patients and 4.4 ± 0.3% in controls. Total IGF-I was 148 ± 7 μg/liter in patients and 178 ± 9 μg/liter in controls (P < 0.001). Free IGF-I, total IGF-II, IGFBP-3, and GH-binding protein were lower, whereas IGFBP-1, IGFBP-1-bound IGF-I, and IGFBP-2 were elevated compared with control values. Patients with detectable C peptide (≥100 pmol/liter) had higher levels of total IGF-I, free IGF-I, and total IGF-II and lower levels of IGFBP-1 and IGFBP-2 than those with an undetectable C peptide level despite having identical average HbA1c. IGFBP-3 proteolysis did not differ between patients and controls. Despite very good glycemic control, patients with type 1 diabetes and no endogenous insulin production have low free and total IGF-I. Residual β-cell function, therefore, seems more important for the disturbances in the IGF system than good metabolic control per se, suggesting that portal insulin delivery is needed to normalize the IGF system.

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Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment

Endocrine ◽

10.1007/s12020-021-02871-2 ◽

2021 ◽

Author(s):

Paulina Surowiec ◽

Bartłomiej Matejko ◽

Marianna Kopka ◽

Agnieszka Filemonowicz-Skoczek ◽

Tomasz Klupa ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Glycemic Control ◽

De Novo ◽

University Hospital ◽

Specialist Care ◽

Good Glycemic Control ◽

Independent Risk Factors

Abstract Purpose Despite progress in type 1 diabetes (T1DM) therapy, diabetic retinopathy (DR) is still a common complication. We analysed predictors and prevalence of DR in patients with T1DM lasting 10 years or more. All of the patients were considered to be currently in excellent glycemic control and treated using modern therapies. Methods Study included 384 (80.7% women) T1DM patients participating in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between the years 2014 and 2020. A retrospective analysis of medical records was conducted. Results The patients were on average 34 ± 9.2 years old, had a BMI 25.0 ± 3.9 and a T1DM duration of 20.5 ± 7.9 years. The mean level of HbA1c throughout the follow-up (mean duration 4.9 ± 1.4 years) was 6.9 ± 1%. The group included 238 (62.0%) patients treated with insulin pumps and 99 (25.8%) on multiple daily injections, 47 (12.2%) used both methods; almost all patients were on insulin analogues. DR was confirmed in 150 (39.1%) patients, from which 109 (28.4%) were diagnosed de novo. Severe DR was occurred in just 31 cases (8.1%). In the multivariate logistic regression, independent risk factors for the presence of DR were T1DM duration (OR 1.13; 95% CI, 1.09–1.19), HbA1c level (OR 1.41; 95% CI, 1.08–1.84), LDL level (OR 1.79; 95% CI, 1.16–2.87), and the combined presence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16–3.03). Conclusions In this highly-selected group of T1DM patients, mostly female, the prevalence of both DR at any stage and severe DR was lower than earlier reported results from other cohorts. Independent risk factors for the DR cohort did not differ from previously reported studies.

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Internet Usage May Improve Quality of Life (QoL) in Type 1 Diabetes Mellitus Patients

Journal of Diabetes Metabolism and its Complications ◽

10.31487/j.jdmc.2020.01.06 ◽

2020 ◽

pp. 1-4

Author(s):

Ravindra Shukla ◽

Divyangi Mishra

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Diabetes Patient ◽

Smart Phones ◽

Good Glycemic Control ◽

Group 4 ◽

Clinical Practise ◽

Use Of Internet ◽

Diabetes Patients

Objective: To delineate the effect of self-gained information through internet on glycemic control and overall QoL in type 1 diabetes patient. Methodology: 35 type 1 diabetes patients, who had reasonably good glycemic control were classified by a single clinician into net- savvy and ordinary based on their behaviour towards use of internet to gather information regarding health queries and their glycemic control and QoL analysed.WHO-5 questionnaire which is used in clinical practise was applied. Result: Of net savvy group (n=18), 14 (82%) had WHO-5 score greater than 13 while among ordinary (n=17) only 7 had WHO5 of same range. Thus, those who surfed internet were in general likely to have better QoL. Among net savvy group all had individual smart phones and used google as search engine. Among ordinary, 40% (9/17) had smart phones. The mean HbA1c of net savvy group was 7.2 which was lower than that of ordinary group mean HbA1c of 7.6. Those of net savvy group were more likely to agree to increase in number of s.c. insulin injections (12/18) as compared to ordinary group (4/17). The self-reported hypoglycemia episodes were also more in net savvy group (6/ person-week) as compared to ordinary (2/ person- week). Conclusion: Use of smart search engines like google (with strong in-built Artificial Intelligence (AI) systems), even if unsupervised, should be encouraged as part of DSME in type 1 Diabetes patients for optimizing glycemic control and detecting hypoglycemic episodes.

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