Improvement of glycemic control without severe hypoglycemia in a type 1 diabetes patient undergoing hemodialysis after a change from insulin glargine to insulin degludec

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

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Acylated-based long-acting insulin analogues: Is “misfolding” the problem? Commentary letter on Hamasaki H and Yanai H. The switching from insulin glargine to insulin degludec reduced HbA1c, daily insulin doses and anti-insulin antibody in anti-insulin antibody-positive subjects with type 1 diabetes

Diabetes & Metabolism ◽

10.1016/j.diabet.2014.10.001 ◽

2014 ◽

Vol 40 (6) ◽

pp. 483-484 ◽

Cited By ~ 1

Author(s):

L. Monnier ◽

C. Colette ◽

D. Owens

Keyword(s):

Type 1 Diabetes ◽

Insulin Glargine ◽

Insulin Analogues ◽

Insulin Degludec ◽

Insulin Antibody ◽

Daily Insulin ◽

Acting Insulin ◽

Long Acting

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Effects of glycemic control on target organ responses to epinephrine in type 1 diabetes

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00311.2004 ◽

2005 ◽

Vol 289 (2) ◽

pp. E258-E265 ◽

Cited By ~ 6

Author(s):

Deanna Aftab Guy ◽

Darleen Sandoval ◽

M. A. Richardson ◽

Donna Tate ◽

Stephen N. Davis

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Blood Pressure Response ◽

Severe Hypoglycemia ◽

Glucose Production ◽

Endogenous Glucose Production ◽

Target Organ ◽

Epinephrine Infusion ◽

Glucose Levels

Severe hypoglycemia occurs in intensively treated patients with type 1 diabetes mellitus (T1DM) due in part to deficient epinephrine counterregulatory responses. Previously, we have found that T1DM patients demonstrated a spectrum of altered responses to epinephrine at a variety of target organs compared with nondiabetic healthy subjects. What is not known is whether intensive glycemic control further modifies target organ responses in individuals with T1DM. Therefore, the aim of this study is to assess whether there is tissue specific (liver, muscle, adipose tissue, pancreas and cardiovascular) resistance to epinephrine in intensively controlled (IC) T1DM compared with those with conventional control (CC). Eight IC patients (age 33 ± 4 yr, BMI 24 ± 2 kg/m2, Hb A1C6.7 ± 0.1%), and 11 CC patients (age 35 ± 3 yr, BMI 25 ± 1 kg/m2, Hb A1C9.6 ± 0.1%) underwent two separate randomized, single-blind, 2-h hyperinsulinemic euglycemic clamp studies with (EPI) and without (NO EPI) epinephrine infusion. Epinephrine levels during EPI were similar in all groups (5,197 ± 344 pmol/l). Glucose (5.3 ± 0.1 mmol/l) and insulin levels (515 ± 44 pmol/l) were similar in all groups during the glucose clamps. Endogenous glucose production (EGP) and glucose uptake (Rd) were determined using [3-H3]glucose. Muscle biopsy was performed at the end of each study. IC had a significantly reduced EGP and Rdresponses to EPI compared with CC. Glucagon responses to EPI were similarly blunted in both IC and CC. Free fatty acid and glycerol response to EPI was greater in CC compared with IC. There was a significantly greater systolic blood pressure response to EPI in CC. We conclude that, despite similar epinephrine, insulin, and glucose levels, intensively treated T1DM patients had reduced cardiovascular, skeletal muscle, hepatic, and adipose target organ responses to EPI compared with conventionally treated T1DM patients.

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