scholarly journals Bariatric surgery in patients with type 1 diabetes: special considerations are warranted

2019 ◽  
Vol 10 ◽  
pp. 204201881882220 ◽  
Author(s):  
Zohar Landau ◽  
Galit Kowen-Sandbank ◽  
Daniela Jakubowicz ◽  
Asnat Raziel ◽  
Nasser Sakran ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Glucose Control ◽  
Healthcare Services ◽  
Short And Long Term ◽  
The Mean

Objective: We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM). Methods: We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years. Results: Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 ( p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 ( p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% ( p = 0.09). Conclusions: Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.

scholarly journals Long-Term Effects of Initiating Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in People with Type 1 Diabetes and Unsatisfactory Diabetes Control

2019 ◽  
Vol 8 (3) ◽  
pp. 394 ◽  
Author(s):  
Jon-Duri Senn ◽  
Stefan Fischli ◽  
Lea Slahor ◽  
Susanne Schelbert ◽  
Christoph Henzen
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Glucose Monitoring ◽  
Subcutaneous Insulin ◽  
Long Term Effects ◽  
The Mean

Background: We aimed to assess the long-term effects of the introduction of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D). Methods: A prospective single-centre cohort study including participants with T1D and HbA1c > 7.5%. After completing a course in flexible intensified insulin treatment (FIT), participants were offered treatment change to CSII/CGM. FIT participants with HbA1c ≤ 7.5% who remained on multiple daily injections (MDI) and without CGM were monitored as a separate cohort to compare the cumulative incidence of diabetic complications. Results: The study cohort included 41 participants with T1D (21 male/20 female). The mean age (±SD) at inclusion was 24.2 ± 10.9 years, the mean follow-up was 8.9 ± 2.8 years, and the mean diabetes duration at the end of the study was 15.9 ± 10.1 years. The mean HbA1c level before the introduction of CSII was 8.8 ± 1.3% (73 ± 8 mmol/mol), and decreased significantly thereafter to 8.0 ± 1.1% (63 ± 7 mmol/mol) (p = 0.0001), and further to 7.6 ± 1.1% (59 ± 11 mmol/mol) after the initiation of CGM (p = 0.051). In the MDI group the HbA1c levels did not change significantly during a mean follow-up of 6.8 ± 3.2 years. The frequency of severe hypoglycaemia after the introduction of CSII/CGM declined significantly (from 9.7 to 2.2 per 100 patient-years, p = 0.03), and the cumulative incidence of newly diagnosed diabetic microvascular complications were comparable between the study group and the observational cohort. Conclusion: In people with T1D and unsatisfactory diabetes control the introduction of CSII and CGM results in a substantial and long-term improvement.

Evaluation of gastric emptying and neuropathy in short- and long-term type-1 diabetes

2006 ◽  
Vol 44 (05) ◽  
Author(s):  
T Várkonyi ◽  
É Börcsök ◽  
R Takács ◽  
R Róka ◽  
C Lengyel ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Gastric Emptying ◽  
Short And Long Term ◽  
Term Type

Short and long-term glycemic variability associated with severe hypoglycemia and retinopathy in type 1 diabetes mellitus

2020 ◽  
Author(s):  
Martín Borja Sanz ◽  
Gimeno Sergio Roman ◽  
Peteiro Miranda Carlos Miguel ◽  
Ortez Toro Jose Jorge ◽  
Ana Agudo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Severe Hypoglycemia ◽  
Glycemic Variability ◽  
Short And Long Term

A long-term evaluation of Facebook for recruitment and retention in the ENDIA type 1 diabetes pregnancy-birth cohort study (Preprint)

2021 ◽  
Author(s):  
Kelly J McGorm ◽  
James David Brown ◽  
Rebecca Louise Thomson ◽  
Helena Oakey ◽  
Belinda Moore ◽  
...  
Keyword(s):  
Social Media ◽  
Type 1 Diabetes ◽  
Logistic Regression ◽  
Birth Cohort ◽  
Multinomial Logistic Regression ◽  
Sociodemographic Characteristics ◽  
Recruitment And Retention

BACKGROUND Recruitment and retention of research participants is challenging. Social media, particularly Facebook, has emerged as a tool for connecting with participants due to its high uptake in the community. The Environmental Determinants of Islet Autoimmunity (ENDIA) study is an Australia-wide prospective pregnancy-birth cohort following children who have a first-degree relative with type 1 diabetes (ACTRN1261300794707). A dedicated Facebook page was established for the ENDIA study in 2013 with the aim to enhance recruitment and support participant retention. OBJECTIVE The purpose of this investigation was to evaluate the long-term impact of Facebook as a recruitment and retention tool. The hypotheses were that (1) Facebook was an important source of referral to the ENDIA study, (2) the sociodemographic characteristics of participants recruited by Facebook would be different from those of participants recruited by other means (i.e., ‘conventional recruits’), and (3) recruitment by Facebook would be associated with long-term retention. We also evaluated the most effective types of Facebook content based on post engagement. METHODS Recruitment of 1511 ENDIA participants was completed in December 2019. Characteristics of participants recruited through Facebook were compared to conventional recruits using linear, logistic, and multinomial logistic regression models. A logistic regression model was used to determine the risk of study withdrawal. Data pertaining to 794 Facebook posts over 7.5 years from June 2013 until December 2020 were extracted using the Facebook ‘Insights’ function for thematic analysis. RESULTS Facebook was the third largest source of referral to the ENDIA study (300/1511; 19.9%) behind in-person clinics (500/1511, 33.1%) and healthcare professional referrals (347/1511, 23.0%). The ENDIA Facebook page had 2337 followers at the close of recruitment. Approximately 20% of these could be identified as participating parents. Facebook recruits were more frequently Australian-born (P<.001) enrolling postnatally (P=.01) and withdrew from the study at a significantly lower rate compared to conventional recruits (4.7% vs 12.3%; P<.001) after a median of follow-up of 3.3 years. CONCLUSIONS Facebook was a valuable recruitment tool for the ENDIA study and participants recruited through Facebook were three times less likely to withdraw during long-term follow-up. The sociodemographic characteristics of Facebook recruits were different to conventional recruits, but perhaps in unintended ways. Facebook content featuring stories and images of participants received the highest engagement despite the fact that most Facebook followers were not enrolled in the study. These findings should inform social media strategies for future cohort studies involving pregnant women and young families, and for type 1 diabetes risk studies. CLINICALTRIAL Australia New Zealand Clinical Trials Registry: ACTRN1261300794707 INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/1471-2431-13-124

scholarly journals Long-Term Hyperglycemia Triggered Growth Pattern of Pediatrics with Type 1 Diabetes -A Five-Year Retrospective Follow-Up Study

2021 ◽  
Vol 2021 (01) ◽  
Author(s):  
Kavita M Sudersanadas ◽  
Maha Al Turki ◽  
Atheer Zaid Abu thyab ◽  
Razan Salim Almutairi ◽  
Winnie Philip ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Growth Pattern ◽  
Follow Up Study

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up

2021 ◽  
Vol 68 (8) ◽  
pp. 567-572
Author(s):  
Nicolás Coronel-Restrepo ◽  
Víctor Manuel Blanco ◽  
Andres Palacio ◽  
Alex Ramírez-Rincón ◽  
Sebastián Arbeláez ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real World ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Long Term Follow Up

scholarly journals Early Glomerular Hyperfiltration and Long-Term Kidney Outcomes in Type 1 Diabetes

2019 ◽  
Vol 14 (6) ◽  
pp. 854-861 ◽  
Author(s):  
Mark E. Molitch ◽  
Xiaoyu Gao ◽  
Ionut Bebu ◽  
Ian H. de Boer ◽  
John Lachin ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Confidence Interval ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Glomerular Hyperfiltration ◽  
Iothalamate Clearance ◽  
Subsequent Risk

Background and objectivesGlomerular hyperfiltration has been considered to be a contributing factor to the development of diabetic kidney disease (DKD). To address this issue, we analyzed GFR follow-up data on participants with type 1 diabetes undergoing 125I-iothalamate clearance on entry into the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications study.Design, setting, participants, & measurementsThis was a cohort study of DCCT participants with type 1 diabetes who underwent an 125I-iothalamate clearance (iGFR) at DCCT baseline. Presence of hyperfiltration was defined as iGFR levels ≥140 ml/min per 1.73 m2, with secondary thresholds of 130 or 150 ml/min per 1.73 m2. Cox proportional hazards models assessed the association between the baseline hyperfiltration status and the subsequent risk of reaching an eGFR <60 ml/min per 1.73 m2.ResultsOf the 446 participants, 106 (24%) had hyperfiltration (iGFR levels ≥140 ml/min per 1.73 m2) at baseline. Over a median follow-up of 28 (interquartile range, 23, 33) years, 53 developed an eGFR <60 ml/min per 1.73 m2. The cumulative incidence of eGFR <60 ml/min per 1.73 m2 at 28 years of follow-up was 11.0% among participants with hyperfiltration at baseline, compared with 12.8% among participants with baseline GFR <140 ml/min per 1.73 m2. Hyperfiltration was not significantly associated with subsequent risk of developing an eGFR <60 ml/min per 1.73 m2 in an unadjusted Cox proportional hazards model (hazard ratio, 0.83; 95% confidence interval, 0.43 to 1.62) nor in an adjusted model (hazard ratio, 0.77; 95% confidence interval, 0.38 to 1.54). Application of alternate thresholds to define hyperfiltration (130 or 150 ml/min per 1.73 m2) showed similar findings.ConclusionsEarly hyperfiltration in patients with type 1 diabetes was not associated with a higher long-term risk of decreased GFR. Although glomerular hypertension may be a mechanism of kidney injury in DKD, higher total GFR does not appear to be a risk factor for advanced DKD.

scholarly journals Women’s Experiences of Day-and-Night Closed-Loop Insulin Delivery During Type 1 Diabetes Pregnancy

2018 ◽  
Vol 12 (6) ◽  
pp. 1125-1131 ◽  
Author(s):  
Conor Farrington ◽  
Zoe Stewart ◽  
Roman Hovorka ◽  
Helen Murphy
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Closed Loop ◽  
Insulin Delivery ◽  
Peace Of Mind ◽  
Women’S Experiences ◽  
Closed Loop Systems ◽  
Women's Experiences

Aims: Closed-loop insulin delivery has the potential to improve day-to-day glucose control in type 1 diabetes pregnancy. However, the psychosocial impact of day-and-night usage of automated closed-loop systems during pregnancy is unknown. Our aim was to explore women’s experiences and relationships between technology experience and levels of trust in closed-loop therapy. Methods: We recruited 16 pregnant women with type 1 diabetes to a randomized crossover trial of sensor-augmented pump therapy compared to automated closed-loop therapy. We conducted semistructured qualitative interviews at baseline and follow-up. Findings from follow-up interviews are reported here. Results: Women described benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and peace of mind were counterbalanced by concerns about technical glitches, CGM inaccuracy, and the burden of maintenance requirements. Women expressed varied but mostly high levels of trust in closed-loop therapy. Conclusions: Women displayed complex psychosocial responses to day-and-night closed-loop therapy in pregnancy. Clinicians should consider closed-loop therapy not just in terms of its potential impact on biomedical outcomes but also in terms of its impact on users’ lives.

scholarly journals Type 1 Choroidal Neovascularization Evolution by Optical Coherence Tomography Angiography: Long-Term Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Marco Rispoli ◽  
Maria Cristina Savastano ◽  
Bruno Lumbroso ◽  
Lisa Toto ◽  
Luca Di Antonio
Keyword(s):  
Optical Coherence Tomography ◽  
Choroidal Neovascularization ◽  
Structural Changes ◽  
Imaging Techniques ◽  
Optical Coherence ◽  
Anti Vegf ◽  
The Mean

Purpose. To evaluate structural changes in response to antivascular endothelial growth factor (anti-VEGF) treatment in patients with long-term type 1 choroidal neovascularization (CNV) by optical coherence tomography (OCT) and OCT angiography (OCTA). Method. This is a longitudinal study that involved a total of 51 eyes with type 1 CNV (35 female and 16 male eyes). Structural OCT and OCTA were performed on all the subjects. AngioVue OCTA (XR Avanti, Optovue, Inc., Fremont, CA) was used to obtain qualitative and quantitative information. All eyes were treated with an anti-VEGF ProReNata (PRN) approach and were followed for a mean of 38.9 months (SD±7.22). Best-corrected visual acuity (BCVA) was assessed at each follow-up timepoint. Results. We observed two kinds of possible evolution of type 1 CNV: “positive evolution,” including stabilization in 20% of patients and chronicity in 35%, and “negative evolution,” in which fibrosis was shown in 18% of patients, chorioretinal atrophy in 25%, and hemorrhage or RPE tears in 2%. The mean BCVA at baseline was 33.67±15.85 ETDRS letters; after 1 and 2 years, it was 31.61±18.04 and 31.18±18.58 ETDRS letters, respectively. The mean BCVA at the end of follow-up was 25.27±20 ETDRS letters. The difference between the values at baseline and at the end of follow-up was not statistically significant (P=0.06, r2=0.10). Conclusions. This study describes an in vivo structural long-term evolution of type 1 CNV by OCT and OCTA. Different possible CNV outcomes were observed. This study suggests that new retinal imaging techniques could be useful tools for assessing the potential retinal changes in the evolution of type 1 CNV to develop personalized medicine. Further studies using OCTA in the long term are needed to better understand why similarly treated type 1 CNV cases evolve differently and produce different results.

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