Large fibre, small fibre and autonomic neuropathy in adolescents with type 1 diabetes: A systematic review

Background: Time-in-range is a key glycaemic metric, and comparisons of management technologies for this outcome are critical to guide device selection. Purpose: We conducted a systematic review and network meta-analysis to compare and rank technologies for time in glycaemic ranges. Data sources: We searched All Evidenced Based Medicine Reviews, CINAHL, EMBASE, MEDLINE, MEDLINE In-Process and other non-indexed citations, PROSPERO, PsycINFO, PubMed, and Web of Science until 24 April, 2019. Study selection: We included randomised controlled trials >2 weeks duration comparing technologies for management of type 1 diabetes in adults (>18 years of age), excluding pregnant women. Data extraction: Data were extracted using a predefined template. Outcomes were percent time with sensor glucose levels 3.9–10.0mmol/l (70–180mg/dL), >10.0mmol/L (180mg/dL), and <3.9mmol/L (70mg/dL). Data synthesis: We identified 16,772 publications, of which 14 eligible studies compared eight technologies comprising 1,043 participants. Closed loop systems lead to greater percent time-in-range than any other management strategy and was 17.85 (95% predictive interval [PrI] 7.56–28.14) higher than usual care of multiple daily injections with capillary glucose testing. Closed loop systems ranked best for percent time-in-range or above range utilising surface under the cumulative ranking curve (SUCRA–98.5 and 93.5 respectively). Closed loop systems also ranked highly for time below range (SUCRA–62.2). Limitations: Overall risk of bias ratings were moderate for all outcomes. Certainty of evidence was very low. Conclusions: In the first integrated comparison of multiple management strategies considering time-in-range, we found that the efficacy of closed loop systems appeared better than all other approaches.

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Silent coeliac disease is not a cause of autonomic neuropathy in patients with Type 1 diabetes

Diabetic Medicine ◽

10.1046/j.1464-5491.2001.05303.x ◽

2001 ◽

Vol 18 (8) ◽

pp. 686-687 ◽

Cited By ~ 2

Author(s):

S. Schmid ◽

O. Schnell ◽

E. Bonifacio ◽

A. G. Ziegler ◽

M. Hummel

Keyword(s):

Type 1 Diabetes ◽

Coeliac Disease ◽

Autonomic Neuropathy

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The virome in early life and childhood and development of islet autoimmunity and type 1 diabetes: A systematic review and meta‐analysis of observational studies

Reviews in Medical Virology ◽

10.1002/rmv.2209 ◽

2020 ◽

Author(s):

Clare L. Faulkner ◽

Yi Xuan Luo ◽

Sonia Isaacs ◽

William D. Rawlinson ◽

Maria E. Craig ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Early Life ◽

Observational Studies ◽

Meta Analysis ◽

Islet Autoimmunity

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Prevalence of Metabolic Syndrome in Children and Adolescents with Type 1 Diabetes Mellitus and Possibilities of Prevention and Treatment: A Systematic Review

Nutrients ◽

10.3390/nu13061782 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1782

Author(s):

Monika Grabia ◽

Renata Markiewicz-Żukowska ◽

Katarzyna Socha

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Type 1 Diabetes ◽

Children And Adolescents ◽

Treatment Options ◽

Overweight And Obesity ◽

Excess Body Weight ◽

Healthy Population ◽

Prevention And Treatment

Overweight and obesity are an increasingly common problem, not only among the healthy population, but also in adolescents with type 1 diabetes (T1DM). Excess body weight is related to many cardiometabolic complications as well as a high risk of metabolic syndrome (MetS). The purpose of this systematic review is to provide a concise and critical overview of the prevalence of MetS in children and adolescents with T1DM and, ultimately, to discuss prevention and treatment options. The study was conducted in accordance with PRISMA guidelines. This review shows that, apart from the growing percentage of overweight and obese children and adolescents with T1DM (on average 20.1% and 9.5%, respectively), the problem of the increasing incidence of MetS (range from 3.2 to 29.9%, depending on the criteria used) is one of the most important phenomena of our time. One of the methods of prevention and treatment is a combined approach: changing eating habits and lifestyle, but there are also reports about the beneficial effects of the gut microflora.

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Efficacy and safety among second-generation and other basal insulins in adult patients with type 1 diabetes: a systematic review and network meta-analysis

Naunyn-Schmiedeberg s Archives of Pharmacology ◽

10.1007/s00210-021-02128-9 ◽

2021 ◽

Author(s):

Martin ◽

Yi Zhou ◽

Tatsuya Takagi ◽

Yu-Shi Tian

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Second Generation ◽

Meta Analysis ◽

Adult Patients ◽

Efficacy And Safety

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Diabetic cardiovascular autonomic neuropathy in children

European Heart Journal ◽

10.1093/ehjci/ehaa946.3200 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

O.L.G.A Gumeniuk ◽

N Bolotova ◽

A Averianov ◽

I.U Chernenkov

Keyword(s):

Heart Rate ◽

Type 1 Diabetes ◽

Autonomic Neuropathy ◽

Hba1c Level ◽

Diabetes Duration ◽

Cardiovascular Autonomic Neuropathy ◽

Deep Breath ◽

Group I ◽

Diabetic Cardiovascular Autonomic Neuropathy

Abstract Diabetic cardiovascular autonomic neuropathy (CAN) encompasses damage to the autonomic nerve fibers innervating the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. Clinical symptoms associated with CAN include resting tachycardia, postural hypotension, dizziness, syncope, exercise intolerance, silent myocardial infarction. The earliest finding of CAN, even at the subclinical stage, is a decrease in heart rate variability (HRV) Purpose To study CAN prevalence and understand the diagnostic capabilities of HRV - tests of diabetic cardiovascular autonomic neuropathy in children with type 1 diabetes. Methods 100 children with type 1 diabetes were assessed for CAN (age 15.2 yrs [9.0–17.8], duration 6.5 yrs [4.0–10.6], HbA1c 8.1% 6.3–9.7]). The degree of compensation of diabetes was estimated according to criteria ISPAD Consensus Guidelines, 2018. Optimal level (HbA1c <7.0%) of compensation was revealed in 62% of children (group I) and nonoptimal in 38% of children (group II). For evaluation of the CAN we used HRV - tests: RR 30:15 ratio, ΔRR quiet breath, ΔRR deep breath, BP response to standing. Results Diabetic cardiovascular autonomic neuropathy was diagnosed in 41 children: in group I – in 6 (29%) and in group II – 35 (71%) children (p=0.00001). The prevalence of DCN correlated with HbA1c level in children and adolescents (groups I and II): ΔRR quiet breath r=−0.47 & r=−0.9; ΔRR deep breath r=−0.65 & r=−0.85; RR30:15 r=−0.77 & r=−0.88 respectively. Prevalence of CAN increased parallel to type 1 diabetes duration (p<0.01). Conclusions Diabetic cardiovascular autonomic neuropathy in children with type 1 diabetes was diagnosed in 41%. Prevalence of diabetic cardiovascular autonomic neuropathy increases parallel to type 1 diabetes duration (p<0.01). In this study we found an association between HRV indexes and HbA1c level. This provides support for HRV - testing to assess diabetic cardiovascular autonomic neuropathy in children. Funding Acknowledgement Type of funding source: None

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