scholarly journals Is diabetic ketoacidosis a good predictor of 5-year metabolic control in children with newly diagnosed type 1 diabetes?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kowalczyk Emilia ◽  
Stypułkowska Aneta ◽  
Majewska Barbara ◽  
Jarzębowska Małgorzata ◽  
Hoffmann Aleksandra ◽  
...  
Keyword(s):  
Metabolic Control ◽  
Insulin Dose ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Daily Insulin Dose ◽  
Early Implementation ◽  
Modern Technologies

Abstract Background The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up. Methods The study included children treated due to newly diagnosed T1D complicated with DKA between 2010 and 2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA1C, total daily insulin dose, basal insulin and BMI-SDS. Results 85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA1C level (7,3%vs7,2%;p = .413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA1C. The method of insulin delivery at baseline was significantly associated with HbA1C levels after 5 years of observation, βCSII = − 1.46,95%CI[− 2.01 to − 0.92],p < .001. Conclusions The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA1C improvement.

scholarly journals Is Diabetic Ketoacidosis A Good Predictor Of 5-Year Metabolic Control in Children with Newly Diagnosed Type 1 Diabetes?

2021 ◽  
Author(s):  
Emilia Kowalczyk ◽  
Aneta Stypułkowska ◽  
Barbara Majewska ◽  
Małgorzata Domaradzka ◽  
Aleksandra Hoffmann ◽  
...  
Keyword(s):  
Metabolic Control ◽  
Insulin Dose ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Daily Insulin Dose ◽  
Early Implementation ◽  
Modern Technologies

Abstract Purpose: The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up.Methods: The study included children treated due to newly diagnosed T1D complicated with DKA between 2010-2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA1C, total daily insulin dose, basal insulin and BMI-SDS.Results: 85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA1C level (7,3%vs7,2%;p=.413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA1C. The method of insulin delivery at baseline was significantly associated with HbA1C levels after 5 years of observation, βCSII=-1.46,95%CI[-2.01 to -0.92],p<.001.Conclusions: The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA1C improvement.

scholarly journals Seven-day Fasting as a multimodal complex intervention for Adults with Type 1 Diabetes – Feasibility, Benefit and Safety in a Controlled Pilot Study

2020 ◽  
Author(s):  
Bettina Berger ◽  
Ekkehart Jenetzky ◽  
Diana Köblös ◽  
Rainer Stange ◽  
Andrea Baumann ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Insulin Dose ◽  
Daily Insulin Dose ◽  
The Metabolic Syndrome ◽  
Average Glucose

Abstract Aims/Hypothesis: Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions like the metabolic syndrome, type 2 diabetes, rheumatic diseases and others. Fasting for people with type 1 diabetes is generally considered too risky. However, the ability and possibility to change from carbohydrate to ketone-based fuel supply may also be relevant for people with type 1 diabetes. The aim of this patient-led research was to investigate the feasibility, benefit and safety of a seven-day multimodal fasting intervention in people with type 1 diabetes. Methods: A non-randomized controlled pilot study, with 20 participants with and 10 without type 1 diabetes with data acquisition toking place prior, post and four months after the intervention and daily during intervention. Results: 29 of 30 participants finished the intervention. Mean ß-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7 while average glucose remained between 4.9 ± 1.5 to 7.5 ± 2.3 mmol/L89 [± 27 and 136 ± 40 mg/dL]. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes. Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54.0 ± 4.4 to 68.8 ± 15.0 (p = 0.01) after fasting. The was a decrease from before until the follow -up four month late of weight from 77.6 ± 20.4 kg to 76.6 ± 20.9 kg (p = 0.023) and for the BMI from (27.68 ± 7.04) to (26.74 ± 7.15) kg/m2 (p = 0.008). Diastolic blood pressure increased from 69.75 ± 11.41 mmHg to 75.74 ± 8.42 mmHg (p = 0.028) and stayed in a healthy range on average. Conclusions/Interpretation: This study demonstrates the feasibility, benefits and safety aspects of a 7-day fast in adults with type 1 diabetes.

scholarly journals Continuous Glucose Monitoring Initiation Within First Year of Type 1 Diabetes Diagnosis Is Associated With Improved Glycemic Outcomes: 7-Year Follow-Up Study

2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K Snell-Bergeon ◽  
Viral N Shah
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
First Year ◽  
Diabetes Diagnosis ◽  
One Year ◽  
Glycemic Outcomes ◽  
Design And Methods

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>

scholarly journals Seven-day Fasting as a multimodal complex interventionfor Adults with Type 1 Diabetes – Feasibility, Benefit and Safety in a Controlled Pilot StudyFeasibility of Fasting for Adults with Type 1 Diabetes 

2020 ◽  
Author(s):  
Bettina Berger ◽  
Ekkehart Jenetzky ◽  
Diana Köblös ◽  
Rainer Stange ◽  
Andrea Baumann ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Randomized Controlled ◽  
Daily Insulin Dose ◽  
The Metabolic Syndrome ◽  
Average Glucose

Abstract Aims/Hypothesis: Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions like the metabolic syndrome, type 2 diabetes, rheumatic diseases and others. Fasting for people with type 1 diabetes is generally considered too risky. However, the ability and possibility to change from carbohydrate to ketone-based fuel supply might also be relevant for people with type 1 diabetes. The aim of this patient-led research was to investigate the feasibility, benefit and safety of a seven-day multimodal fasting intervention in people with type 1 diabetes. Methods: A non-randomized controlled pilot study, with 20 participants with and 10 without type 1 diabetes. Data acquisition took place prior, post and four months after the intervention and daily during intervention. Results: 29 of 30 participants finished the intervention. Mean ß-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7 while average glucose remained between 4.9 ± 1.5 to 7.5 ± 2.3 mmol/L [89 ± 27 and 136 ± 40 mg/dL]. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes. Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54.0 ± 4.4 to 68.8 ± 15.0 (p = 0.01) after fasting. There was a decrease from before until the follow-up four month later of weight from 77.6 ± 20.4 kg to 76.6 ± 20.9 kg (p = 0.023) and for the BMI from (27.68 ± 7.04) to (26.74 ± 7.15) kg/m2 (p = 0.008). Diastolic blood pressure increased from 69.75 ± 11.41 mmHg to 75.74 ± 8.42 mmHg (p = 0.028) and stayed in a healthy range on average. Conclusions/Interpretation: This study demonstrates the feasibility, benefits and safety aspects of a 7-day fast in adults with type 1 diabetes.

scholarly journals Subclinical peripheral neuropathy in type 1 diabetic adolescents and its relationship with metabolic control

2005 ◽  
Vol 133 (7-8) ◽  
pp. 358-362 ◽  
Author(s):  
Silvija Sajic ◽  
Rada Petrovic
Keyword(s):  
Metabolic Control ◽  
Significant Relationship ◽  
Metabolic Regulation ◽  
Insulin Dose ◽  
Vascular Complications ◽  
Insulin Dosage ◽  
Neural Dysfunction ◽  
Hba1c Levels

Professional management of paediatric diabetology, according to consensus guidelines, involves the screening of micro-vascular complications at puberty. The subclinical form of peripheral neural dysfunction in diabetic teenagers is reported with a frequency of 50-88%, by different authors. The purpose of this study was to evaluate the frequency of subclinical distal neuropathy (DSMN) in type 1 diabetic pediatric patients during the second decade of life, and its relationship with metabolic control. The Endocrinology Department and the Neurology-Physiology Laboratory of the Pediatric Clinic in Belgrade carried out a longitudinal follow-up study (lasting 18 months, beginning in November 2000) on a selection of patients with poor metabolic control. During routine clinical treatment, patients were evaluated using the electrophysiological diagnostic method on peripheral neural dysfunction, a subclinical form of neuropathy. Metabolic control was manifested through HbA1c levels, measured every 3 months, using ion-exchange chromatography. Finally, here is the data collected from the clinical follow-up investigation of 60 children, aged 13-19 (median 1S.S?2.2), with duration of diabetes from 2-16 years (median b.3?3.b), and on the following therapies: 43 CT-conventional and 17 IIT-intensive, and insulin dose/day, median 1.02 (0.6-2.1) U/kg. Detected DSMN parameters at the beginning and at the end of the study were also noted. DSMN frequency was positive, at 64% for HbA1c of 9.44; DSMN dysfunction was reversed in 5% of the patients, for HbA1c of 10.17; the worst result was the progression of DSMN at 6.7% for HbA1c of 10.52; 6.7% had negative DSMN, with improved metabolic control, for HbA1c of 8.4; 15% of the examinations were unfinished (+/*). ANOVA statistical analysis showed a significant statistical relationship between metabolic control (HbA1c levels) and DSMN neuropathy (sig. 0.043, p<0.05). There was no significant relationship between the reversion of DSMN and improved HbA1c, although a numeric distinction did exist. On the clinical aspect, there was a significant relationship between insulin dosage and age (p<0.01, sig. 0.007). This data demonstrates the influence of metabolic regulation on neuropathy. Better metabolic control can slow the progression of subclinical peripheral neural dysfunction (DSMN) in diabetic children.

scholarly journals Continuous Glucose Monitoring Initiation Within First Year of Type 1 Diabetes Diagnosis Is Associated With Improved Glycemic Outcomes: 7-Year Follow-Up Study

2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K Snell-Bergeon ◽  
Viral N Shah
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
First Year ◽  
Diabetes Diagnosis ◽  
One Year ◽  
Glycemic Outcomes ◽  
Design And Methods

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>

scholarly journals Characteristics and Determinants of Partial Remission in Children with Type 1 Diabetes Using the Insulin-Dose-Adjusted A1C Definition

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Aurore Pecheur ◽  
Thierry Barrea ◽  
Valérie Vandooren ◽  
Véronique Beauloye ◽  
Annie Robert ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Partial Remission ◽  
Insulin Dose ◽  
Cell Mass ◽  
Severe Hypoglycemia ◽  
C Peptide ◽  
Antibody Titers

To evaluate the characteristics and determinants of partial remission (PR) in Belgian children with type 1 diabetes (T1D), we analyzed records of 242 children from our center. Clinical and biological features were collected at diagnosis and during follow-up. PR was defined using the insulin-dose-adjusted A1C definition. PR occurred in 56.2% of patients and lasted 9.2 months (0.5 to 56.6). 25.6% of patients entered T1D with DKA, which correlated with lower PR incidence (17.6% versus 82.3% when no DKA). In our population, lower A1C levels at diagnosis were associated with higher PR incidence and in young children (0–4 years) initial A1C levels negatively correlated with longer PR. Early A1C levels were predictive of PR duration since 34% of patients had long PRs (>1 year) when A1C levels were ≤6% after 3 months whereas incidence of long PR decreased with higher A1Cs. C-peptide levels were higher in patients entering PR and remained higher until 3 years after diagnosis. Initial antibody titers did not influence PR except for anti-IA2 titers that correlated with A1C levels after 2 years. Presence of 2 versus 1 anti-islet antibodies correlated with shorter PR. PR duration did not influence occurrence of severe hypoglycemia or diabetes-related complications but was associated with lower A1C levels after 18 months. We show that, at diagnosis of T1D, parameters associated withβ-cell mass reserve (A1C, C-peptide, and DKA) correlate with the occurrence of PR, which affects post-PR A1C levels. Further research is needed to determine the long-term significance of PR.

scholarly journals Continuous Glucose Monitoring Initiation Within First Year of Type 1 Diabetes Diagnosis Is Associated With Improved Glycemic Outcomes: 7-Year Follow-Up Study

2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K Snell-Bergeon ◽  
Viral N Shah
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
First Year ◽  
Diabetes Diagnosis ◽  
One Year ◽  
Glycemic Outcomes ◽  
Design And Methods

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>

scholarly journals Continuous Glucose Monitoring Initiation Within First Year of Type 1 Diabetes Diagnosis Is Associated With Improved Glycemic Outcomes: 7-Year Follow-Up Study

Diabetes Care ◽  
2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K. Snell-Bergeon ◽  
Viral N. Shah
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
First Year ◽  
Diabetes Diagnosis ◽  
Glycemic Outcomes ◽  
Design And Methods

OBJECTIVE To evaluate long-term glycemic outcomes of continuous glucose monitoring (CGM) initiation within the first year of type 1 diabetes diagnosis. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (N = 396) were divided into three groups: 1) CGM (CGM use within 1 year of diabetes diagnosis and continued through the study); 2) no-CGM (no CGM use throughout the study); and 3) new-CGM (CGM use after 3 years since diabetes diagnosis). Patients were followed up to 7 years. RESULTS A1c was significantly lower in the CGM compared with the no-CGM group throughout 7 years of follow-up (least squares mean A1c values: 6 months, 7.3% vs. 8.1%; 1 year, 7.4% vs. 8.6%; 2 years, 7.7% vs. 9.1%; 3 years, 7.6% vs. 9.3%; 4 years, 7.4% vs. 9.6%; 5 years, 7.6% vs. 9.7%; 6 years, 7.5% vs. 10.0%; and 7 years, 7.6% vs. 9.8%; for all, P &lt; 0.001) adjusting for age at diagnosis, sex, and insulin delivery method. CONCLUSION CGM initiation within first year of type 1 diabetes diagnosis results in long-term improvement in A1c.

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