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 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.

Adequate Structured Inpatient Diabetes Intervention in People With Type 1 Diabetes Improves Metabolic Control and Frequency of Hypoglycaemia

2019 ◽  
Vol 128 (12) ◽  
pp. 796-803 ◽  
Author(s):  
Katharina Burghardt ◽  
Ulrich Alfons Müller ◽  
Nicolle Müller ◽  
Christof Kloos ◽  
Guido Kramer ◽  
...  
Keyword(s):  
Metabolic Control ◽  
Insulin Treatment ◽  
Severe Hypoglycaemia ◽  
Insulin Dose ◽  
Insulin Dosage ◽  
Inpatient Diabetes ◽  
Before And After ◽  
Diabetes Intervention ◽  
One Year

Abstract Objective Several studies evaluated inpatient diabetes teaching and treatment programmes (DTTP) in diabetes type 1 (DM1) many years ago, but in these studies insulin treatment was not yet intensified before the DTTP. Today, most patients are already on intensified insulin treatment before entering a DTTP. The aim of this trial was to evaluate the outcome one year after participation in an inpatient intervention including a DTTP in a longitudinal study. Methods 109 patients participated in an inpatient intervention in 2014. All individuals were invited to participate in an outpatient follow-up visit after one year. Results Ninety participants (52.2% female, age 48.0 y, diabetes duration 19.1 y, 31.1% CSII, HbA1c 7.9% / 63.3 mmol/mol) were followed-up after 1.2±0.3 y [1 died, 18 declined / were not available]. 83 / 90 individuals participated to optimise diabetes therapy, 7 / 90 had newly-diagnosed DM1. In the optimisation group, HbA1c decreased by 0.4% (p=0.009) without change of insulin dose (54 IU/day before and after) or BMI (26 kg/m2 before and after). In people with baseline HbA1c ≥7.5% (n=26 / 83), HbA1c decreased by 0.9%. The frequency of severe hypoglycaemia decreased from 0.22 to 0.05 events / year (p=0.045). In people with frequent non severe hypoglycaemia (n=8), events decreased from 4.5±2.0 to 2.8±0.9 / week (p=0.358). Systolic (−6.5 mmHg, p=0.035) and diastolic (−3.4 mmHg, p=0.003) blood pressure improved without change of number of antihypertensive medication (1.9±2.1 vs. 1.8±2.0, p=0.288). Conclusions In people with DM1, metabolic control improved after the inpatient intervention without increasing insulin dosage or BMI. The inpatient intervention remains effective to substantially improve metabolic control under the present circumstances of care.

scholarly journals Personal and Clinical Predictors of Poor Metabolic Control in Children with Type 1 Diabetes in Jordan

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Abeer Alassaf ◽  
Rasha Odeh ◽  
Lubna Gharaibeh ◽  
Sarah Ibrahim ◽  
Kamel Ajlouni
Keyword(s):  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Insulin Dose ◽  
Retrospective Chart Review ◽  
Personal Characteristics ◽  
Team Approach ◽  
Clinical Predictors ◽  
Poor Metabolic Control ◽  
Hba1c Levels

Background. Achieving adequate metabolic control in children with type 1 diabetes is important in slowing the progression of future microvascular and macrovascular complications, but still it is a universal challenge. We aim to investigate possible factors associated with poor metabolic outcomes in Jordan as an example of a country with limited resources. Methods. This is a retrospective chart review study of children with type 1 diabetes. Several clinical and personal characteristics were tested for association with metabolic control reflected by HbA1c levels. Linear logistic regression analysis was used to evaluate possible predictors of metabolic control. One-way ANOVA analysis was used to detect significant differences in HbA1c between categories. Results. Significant predictors of metabolic control were found. A one-year increase in age led to an increase in HbA1c by 0.053% (P=0.044). A decline in HbA1c levels was predicted in children who have precise amount of carbohydrates or who are receiving insulin at school (-0.46% (P=0.014) and -0.82% (P=0.004), respectively). When family members other than mothers decided the insulin dose, the HbA1c level increased by 0.74% (P=0.005). Conclusion. Poor metabolic control was associated with age, dietary noncompliance, not receiving insulin at school, and absence of direct mother care. Our study is one of the few studies from Middle East evaluating predictors of metabolic control. Global research studies help in giving universal insight towards developing more effective multidisciplinary team approach for diabetes care and education.

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.

Insulin Dose Adjustment Following Bariatric Surgery, a Review of Available Literature

2021 ◽  
pp. 193229682110288
Author(s):  
Lynn E. Kassel ◽  
Jessica J. Berei ◽  
Jamie M. Pitlick ◽  
Joel E. Rand
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Appraisal Tool

Bariatric surgery is a known and effective treatment for type 2 diabetes mellitus. Patients with type 1 diabetes mellitus and exogenous insulin-requiring type 2 diabetes mellitus require adjusted insulin dosing after surgery to avoid hypoglycemia. This review describes insulin dose adjustments following a variety of bariatric procedures. After searching the available literature and assessing for eligibility, 8 articles were included. The Johns Hopkins Research Evidence Appraisal Tool for literature appraisal was used. The results of this review reveal insulin dose adjustment varies based upon surgical procedure type and time of follow-up from the procedure.

scholarly journals Effectiveness of Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion for Children with Type 1 Diabetes Mellitus in Clinical Practice

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Chun-xiu Gong ◽  
Li-ya Wei ◽  
Di Wu ◽  
Bing-yan Cao ◽  
Xi Meng ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Control ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Blood Glucose Control ◽  
Insulin Dosage ◽  
Subcutaneous Insulin ◽  
Multiple Daily Injections ◽  
Hba1c Levels

Aims. To determine whether multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) contributes to better glucose control in children with different type 1 diabetes duration.Methods. Subjects were grouped according to early (≤1 year after disease onset; 1A) or late (1–3 years after onset; 2A) MDIs/CSII treatment initiation. Corresponding control groups (1B, 2B) received insulin injections twice daily.Results. HbA1c levels were consistently lower in group 1A than in group 1B (6 months (T2): 7.37% versus 8.21%; 12 months (T3): 7.61% versus 8.41%; 24/36 months (T4/T5): 7.61% versus 8.72%; allP<0.05), but were lower in group 2A than in group 2B only at T2 (8.36% versus 9.19%;P=0.04). Levels were lower in group 1A than in group 2A when disease duration was matched (7.61% versus 8.49%;P<0.05). Logistic regression revealed no correlation between HbA1c level and MDIs/CSII therapy. HbA1c levels were only negatively related to insulin dosage.Conclusions. Blood glucose control was better in patients receiving MDIs/CSII than in those receiving conventional treatment. Early MDIs/CSII initiation resulted in prolonged maintenance of low HbA1c levels compared with late initiation. MDIs/CSII therapy should be combined with comprehensive management.

scholarly journals Impact of ELKa, the Electronic Device for Prandial Insulin Dose Calculation, on Metabolic Control in Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Agnieszka Kowalska ◽  
Katarzyna Piechowiak ◽  
Anna Ramotowska ◽  
Agnieszka Szypowska
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Metabolic Control ◽  
Electronic Device ◽  
Intervention Group ◽  
Insulin Dosage ◽  
Control Group ◽  
Prandial Insulin

Background. The ELKa system is composed of computer software, with a database of nutrients, and a dedicated USB kitchen scale. It was designed to automatize the everyday calculations of food exchanges and prandial insulin doses. Aim. To investigate the influence of the ELKa on metabolic control in children with type 1 diabetes mellitus (T1DM). Methods. A randomized, parallel, open-label clinical trial involved 106 patients aged <18 years with T1DM, HbA1C≤10%, undergoing intensive insulin therapy, allocated to the intervention group, who used the ELKa (n=53), or the control group (n=53), who used conventional calculation methods. Results. After the 26-week follow-up, the intention-to-treat analysis showed no differences to all endpoints. In per protocol analysis, 22/53 (41.5%) patients reporting ELKa usage for >50% of meals achieved lower HbA1C levels (P=0.002), lower basal insulin amounts (P=0.049), and lower intrasubject standard deviation of blood glucose levels (P=0.023) in comparison with the control. Moreover, in the intervention group, significant reduction of HbA1C level, by 0.55% point (P=0.002), was noted. No intergroup differences were found in the hypoglycemic episodes, BMI-SDS, bolus insulin dosage, and total daily insulin dosage. Conclusions. The ELKa system improves metabolic control in children with T1DM under regular usage. The trial is registered at ClinicalTrials.gov, number NCT02194517.

scholarly journals Association of Insulin Dose, Cardiometabolic Risk Factors, and Cardiovascular Disease in Type 1 Diabetes During 30 Years of Follow-up in the DCCT/EDIC Study

Diabetes Care ◽  
2019 ◽  
Vol 42 (4) ◽  
pp. 657-664 ◽  
Author(s):  
Barbara H. Braffett ◽  
Samuel Dagogo-Jack ◽  
Ionut Bebu ◽  
William I. Sivitz ◽  
Mary Larkin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Cardiometabolic Risk ◽  
Insulin Dose ◽  
Cardiometabolic Risk Factors

scholarly journals Different insulin treatment regimens in patient with diabetes mellitus type 1: Effects on quality of life

2012 ◽  
Vol 69 (7) ◽  
pp. 569-575 ◽  
Author(s):  
Jelena Stojanovic ◽  
Dragoslav Milosevic ◽  
Ilija Antovic ◽  
Goran Sekulic ◽  
Teodora Beljic-Zivkovic
Keyword(s):  
Glycemic Control ◽  
Metabolic Control ◽  
Insulin Treatment ◽  
Vascular Complications ◽  
Well Being ◽  
Insulin Analogues ◽  
Treatment Regimens ◽  
Type 1 Dm

Background/Aim. Despite of contemporary diabetes mellitus (DM) treatment, one half of patients do not achieve an optimal metabolic control. Considering great psychological burden of diabetic patients, the purpose of this study was to assess the effect of different insulin treatment regimens, glycemic control and the presence of vascular complications on self-reported well-being and quality of life (QoL) of subjects with type 1 DM. Methods. The patients with type 1 DM (n = 122) recruited from the outpatient Diabetes Endocrinology Clinic of Zvezdara University Medical Center were divided into 4 groups according to the specific treatment regimen: 26 were on continuous subcutaneous insulin infusion (CSII), 30 on conventional insulin therapy, 33 on multiple daily injections (MDI) with human insulins, and 33 on MDI with insulin analogues. QoL was assessed by self-reported well-being with the following questionnaires: WHO-5 item Well Being Index (WHO- 5), 36 item Short Form (SF-36) survey, and Insulin Treatment Appraisal Scale (ITAS). Objective metabolic control was assessed by glycosylated hemoglobin (HbA1c), lipid levels and the presence of vascular complications. Statistical analyses used in this crosssectional study included: descriptive statistics, Student?s t-test, Chisqare test, contingency tables, ANOVA and correlation methods. Results. The patients on CSII had significantly better metabolic control than all other treatment groups, especially when compared to the one on conventional therapy (CSII HbA1c 7.07 ? 1.48% vs conventional therapy, HbA1c 10.04 ? 1.44; p = 0.000). No significant difference in glycemic control was observed between patients on MDI with human insulins and insulin analogues. Good glycemic control significantly influenced the reported QoL. The patients with retinopathy and nephropathy reported significantly lower physical well-being, and the patients with polyneuropathy and cardiovascular complications reported also lower psychological well being. Conclusions. Insulin treatment regiment selection affects not only objective metabolic control, but also QoL.

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