Adolescence and emerging adulthood

2016 ◽  
Author(s):  
David Levy
Keyword(s):  
Smoking Cessation ◽  
Glycaemic Control ◽  
General Population ◽  
Emerging Adulthood ◽  
Early Onset ◽  
Microvascular Complications ◽  
Macrovascular Disease ◽  
The Past ◽  
Adult Diabetes

Adolescence and emerging childhood forms an increasing proportion of the lifespan of urbanized individuals. Glycaemic control worsens during adolescence; physiology and psychology contribute. A1C levels peak around 9% (75 mmol/mol) before declining from late teens onwards. However, unchanging glycaemia (tracking) is common. Glycaemia has generally improved in the past 10–15 years, but significant differences between and within countries persist. Microvascular complications are prevalent at this stage, but have probably also decreased with time. During this important period, the stage can be set for premature macrovascular disease (early onset hypertension, arterial stiffening, dyslipidaemia, and smoking). Exercise reduces the risk of microvascular complications. Smoking is as common in young Type 1 patients than in the general population. Efforts at smoking cessation need reinforcing. Glycaemic control during university does not improve. Transition from paediatric to adult diabetes services is often unsatisfactory; clinics should implement simple procedures focusing on accessibility, flexibility, and improved communications.

scholarly journals Management of diabetes complications in youth

2019 ◽  
Vol 10 ◽  
pp. 204201881986322 ◽  
Author(s):  
Lara E. Graves ◽  
Kim C. Donaghue
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Complications ◽  
Microvascular Complications ◽  
Macrovascular Disease ◽  
Macrovascular Complications ◽  
Invasive Treatment ◽  
Positive Effects

Type 1 and type 2 diabetes are increasing in prevalence and diabetes complications are common. Diabetes complications are rarely studied in youth, despite the potential onset in childhood. Microvascular complications of diabetes include retinopathy, diabetic kidney disease or nephropathy, and neuropathy that may be somatic or autonomic. Macrovascular disease is the leading cause of death in patients with type 1 diabetes. Strict glycaemic control will reduce microvascular and macrovascular complications; however, they may still manifest in youth. This article discusses the diagnosis and treatment of complications that arise from type 1 and type 2 diabetes mellitus in youth. Screening for complications is paramount as early intervention improves outcome. Screening should commence from 11 years of age depending on the duration of type 1 diabetes or at diagnosis for patients with type 2 diabetes. Diabetic retinopathy may require invasive treatment such as laser therapy or intravitreal antivascular endothelial growth factor therapy to prevent future blindness. Hypertension and albuminuria may herald diabetic nephropathy and require management with angiotensin converting enzyme (ACE) inhibition. In addition to hypertension, dyslipidaemia must be treated to reduce macrovascular complications. Interventional trials aimed at examining the treatment of diabetes complications in youth are few. Statins, ACE inhibitors and metformin have been successfully trialled in adolescents with type 1 diabetes with positive effects on lipid profile, microalbuminuria and measures of vascular health. Although relatively rare, complications do occur in youth and further research into effective treatment for diabetes complications, particularly therapeutics in children in addition to prevention strategies is required.

scholarly journals A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection

Diabetologia ◽  
2021 ◽  
Author(s):  
Yue Ruan ◽  
◽  
Robert E. J. Ryder ◽  
Parijat De ◽  
Benjamin C. T. Field ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Primary Outcome ◽  
Microvascular Complications ◽  
Laboratory Data ◽  
Macrovascular Disease ◽  
Risk Of Death ◽  
The Uk

Abstract Aims/hypothesis The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. Methods A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. Results Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55–74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. Conclusions/interpretation In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. In people with Type 1 diabetes and COVID-19 admitted to hospital in the UK, BMI and one or more microvascular complications had a positive association and low serum creatine levels had a negative association with death/admission to intensive care unit after adjusting for age.

What role for metformin in type 1 diabetes?

2018 ◽  
Vol 56 (7) ◽  
pp. 78-80 ◽  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Adjuvant Therapy ◽  
Insulin Therapy ◽  
Clinical Guidelines ◽  
Standard Treatment ◽  
Microvascular Complications ◽  
Tight Glycaemic Control

Tight glycaemic control is key to reducing the risk of cardiovascular and microvascular complications in people with type 1 diabetes.1 Standard treatment involves optimising insulin therapy to achieve an HbA1c level of 48mmol/mol (6.5%) or lower. Although not licensed for use in type 1 diabetes, metformin is included in some clinical guidelines as adjuvant therapy for people with type 1 diabetes who are overweight and wish to improve glycaemic control while minimising the dose of insulin.1,2 The REMOVAL study is the largest trial to date that has investigated the longer-term effects of metformin in people with type 1 diabetes.3 Here, we consider the role of metformin in individuals with type 1 diabetes in light of these results and other study findings.

scholarly journals Poor glycaemic control is associated with increased risk of neurodevelopmental disorders in childhood-onset type 1 diabetes: a population-based cohort study

Diabetologia ◽  
2021 ◽  
Author(s):  
Shengxin Liu ◽  
Ralf Kuja-Halkola ◽  
Henrik Larsson ◽  
Paul Lichtenstein ◽  
Jonas F. Ludvigsson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
General Population ◽  
Neurodevelopmental Disorders ◽  
Neurodevelopmental Disorder ◽  
Childhood Onset ◽  
Poor Glycaemic Control ◽  
Onset Type ◽  
Increased Risk

Abstract Aims/hypothesis The aim of this study was to investigate the effect of childhood-onset type 1 diabetes on the risk of subsequent neurodevelopmental disorders, and the role of glycaemic control in this association. We hypothesised that individuals with poor glycaemic control may be at a higher risk of neurodevelopmental disorders compared with the general population, as well as compared with individuals with type 1 diabetes with adequate glycaemic control. Methods This Swedish population-based cohort study was conducted using data from health registers from 1973 to 2013. We identified 8430 patients with childhood-onset type 1 diabetes (diagnosed before age 18 years) with a median age of diabetes onset of 9.6 (IQR 5.9–12.9) and 84,300 reference individuals from the general population, matched for sex, birth year and birth county. Cox models were used to estimate the effect of HbA1c on the risk of subsequent neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability. Results During a median follow-up period of 5.6 years, 398 (4.7%) individuals with type 1 diabetes received a diagnosis of any neurodevelopmental disorder compared with 3066 (3.6%) in the general population, corresponding to an adjusted HR (HRadjusted) of 1.31 (95% CI 1.18, 1.46) after additionally adjusting for other psychiatric morbidity prior to inclusion, parental psychiatric morbidity and parental highest education level. The risk of any neurodevelopmental disorder increased with HbA1c levels and the highest risk was observed in patients with mean HbA1c >8.6% (>70 mmol/mol) (HRadjusted 1.90 [95% CI 1.51, 2.37]) compared with reference individuals without type 1 diabetes. In addition, when compared with patients with diabetes with HbA1c <7.5% (<58 mmol/mol), patients with HbA1c >8.6% (>70 mmol/mol) had the highest risk of any neurodevelopmental disorder (HRadjusted 3.71 [95% CI 2.75, 5.02]) and of specific neurodevelopmental disorders including ADHD (HRadjusted 4.16 [95% CI 2.92, 5.94]), ASD (HRadjusted 2.84 [95% CI 1.52, 5.28]) and intellectual disability (HRadjusted 3.93 [95% CI 1.38, 11.22]). Conclusions/interpretation Childhood-onset type 1 diabetes is associated with an increased risk of neurodevelopmental disorders, with the highest risk seen in individuals with poor glycaemic control. Routine neurodevelopmental follow-up visits should be considered in type 1 diabetes, especially in patients with poor glycaemic control. Graphical abstract

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