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.

scholarly journals MON-086 Various Subcutaneous Continuous Glucose Monitors Comparably Lower HbA1c in Children

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Steven Gold ◽  
Liam McGuirk ◽  
James Haigney ◽  
Jane Torres ◽  
Tara Patale ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Metabolic Control ◽  
Glucose Monitoring ◽  
Initial Visit ◽  
High Hba1c ◽  
The Difference ◽  
Continuous Glucose Monitors ◽  
Type 1 Dm ◽  
Hba1c Levels

Abstract Background: Preliminary studies have demonstrated improvement in metabolic control of patients (PTs) using subcutaneous Continuous Glucose Monitoring systems (CGMs). In this study, we investigated the effect of CGMs on PTs’ glycemic control and compared the change in patient HbA1c levels between sensors. Objective: To determine how CGMs affect metabolic control in PTs and the effect of different sensors on glycemic control. Patients and Methods: 33 PTs with Type 1 diabetes mellitus (DM) who began using a CGM between 2017 and 2019 were selected for inclusion. CGM systems used included DexcomG6™, DexcomG5™, DexcomG4™, Enlite™, Guardian 3™, or Medtronic Sure-T™ sensors. Results: The mean (MN) age of PTs at initial visit was 15.3 ± 5.1 yrs and the MN age at second visit was 15.8 ± 5.1 yrs. The MN time between visits was 5.0 ± 2.4 months (mos). 6 PTs had follow up (F/U) times less than 3 mos, 18 PTs had F/U times between 3 and 6 mos, 6 PTs had F/U times between 6 and 9 mos, and 3 PTs had F/U times greater than 9 mos. The MN and median (MD) HbA1c at the initial visit for all PTs was 8.28% ± 1.48 and 8.10%, respectively. The MN and MD HbA1c at final F/U for all PTs was 7.57% ± 1.11 and 7.50%, respectively. The difference in MN HbA1c was significant (p<0.001). The MN and MD HbA1c at the initial visit for PTs with a F/U time less than 3 mos was 7.55% ± 0.77 and 7.75%, respectively. The MN and MD HbA1c at F/U for these PTs was 7.20% ± 0.79 and 7.20%, respectively. The difference in MN HbA1c was significant (p<0.05). The MN and MD HbA1c at the initial visit for all PTs with a F/U time greater than 3 mos was 8.44% ± 1.53 and 8.10%, respectively. The MN and MD HbA1c at F/U for these PTs was 7.66% ± 1.15 and 7.50%, respectively. The difference in MN HbA1c was significant (p<0.001). The MN change of HbA1c between visits was not significant between PTs who had 3–6 mo, 6–9 mo, and 9+ mo F/U times (p=0.96) 15 PTs had HbA1c levels less than or equal to 8.0%. The MN and MD HbA1c at initial visit for these PTs was 7.20% ± 0.41 and 7.30%, respectively. The MN and MD HbA1c at F/U for these PTs was 6.75% ± 0.47 and 6.80%, respectively. The difference in MN HbA1c was significant (p<0.001). 20 PTs had HbA1c levels greater than 8.0% at initial visit. The MN and MD HbA1c at the initial visit for these PTs was 9.18% ± 1.47 and 8.80%, respectively. The MN and MD HbA1c at F/U for these PTs was 8.26% ± 1.03 and 8.00%, respectively. The difference in MN HbA1c was significant (p<0.001). The MN change in HbA1c between the high HbA1c group (-.92% ± 1.02) and low HbA1c group (-0.45% ± 0.32) was not significant (p>0.05). 25 PTs used a Dexcom™ sensor while 8 PTs used a Medtronic™ sensor. The MN change in HbA1c was not significant between these brands (p>0.05). Conclusion: CGMs improve metabolic control in pediatric PTs with Type 1 DM regardless of initial HbA1c. Further, this improved control is sustained over time. Sensor brands appear to be equally effective at achieving this goal.

Cognitive functions and glycemic control in children and adolescents with type 1 diabetes

2009 ◽  
Vol 40 (1) ◽  
pp. 95-103 ◽  
Author(s):  
S. Ohmann ◽  
C. Popow ◽  
B. Rami ◽  
M. König ◽  
S. Blaas ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Metabolic Control ◽  
Child Behavior Checklist ◽  
Diabetes Management ◽  
Social Activity ◽  
Self Report ◽  
Patients With Diabetes

BackgroundThe relationship between metabolic control and cognitive function in adolescents with type 1 diabetes (DM type 1) is not clear. We compared the quality of glycemic control (GC) and cognitive measures in adolescents with DM type 1 to find out if the quality of diabetes management is related to cognitive impairment.MethodWe assessed executive functions (EFs) and other neuropsychological and psychosocial variables in 70 adolescent patients with DM type 1 and 20 age-matched controls. Patients were divided into two groups according to their last hemoglobin A1c (HbA1c): acceptable (HbA1c 5.9–8.0%, mean 6.9%, 36 patients, mean age 14 years) and non-optimal (HbA1c 8.2–11.6%, mean 9.3%, 34 patients, mean age 15.6 years).ResultsWe found impaired EFs, mainly problems of concept formation (p=0.038), cognitive flexibility (p=0.011) and anticipation (p=0.000), in the patients with DM type 1. Both groups did not differ in intelligence, most assessed EFs and adjustment to chronic illness (Youth Self-Report; YSR). Younger patients (<15 years) were cognitively less flexible. GC was worse in older patients and in patients with longer duration of the disease. We also found significant differences between patients with diabetes and controls concerning somatic complaints, internalizing problems (Child Behavior Checklist; CBCL) and social activity (CBCL and YSR).ConclusionsDM type 1 is associated with cognitive deficits in adolescents independent of the quality of metabolic control and the duration of the disease. These deficits are probably related to the disease, especially in patients with early-onset diabetes.

The influence of a program of structured diabetes education on the glycemic control and quality of life during transition of the patients with type 1 diabetes mellitus to insulin pump therapy with continuous real-time monitoring blood glucose leve

2014 ◽  
Vol 60 (1) ◽  
pp. 39-45
Author(s):  
L I Ibragimova ◽  
Yu I Philippov ◽  
A Yu Mayorov
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Diabetes Education ◽  
Well Being ◽  
Control Group

Aim of the study. To estimate the effectiveness of the new program of structured diabetes education for the groups of the patients with type 1 diabetes mellitus (DM1) during their transition to sensor-augmented pump (SAP) therapy in terms of improvement of the glycemic control and quality of life (QL). Material and methods. The study included 35 patients presenting with DM1: 14 men, mean age 26.5 years (24; 36). The patients were divided into two groups. Those in the study group received a structured diabetes education (n=19), those in the control group were given conventional education (n=16). The patients of group 1 were transferred to SAP therapy in the framework of group education based on the specialized structured program. The education of control patients was carried out on an individual basis in the previous period at the places of residence. Quality of life and emotional well-being were estimated with the use of the validated Russian versions of the SF-36, ADDQoL, and WB-Q12 questionnaires. The effectiveness of glycemic control and QL were evaluated within 4 months after the completion of education and transition to SAP. Results. The patients of both groups were not initially different in the HbA1c level: 8.1 (8.0; 9.2) versus 8.8 (7.7; 9.0) (p>0.05). The HbA1c level: decreased in the two groups within 4 months after the initiation of SAP therapy: 7.3 (6.3; 7.8) versus 8.0 (6.3; 8.5) (p>0.05). The decrease was more pronounced in the group of the patients who received the structured diabetes education than in the control group (p=0.036). The patients transferred to SAP in the framework of the structured education program tended to have higher indices of QL and emotional well-being than the patients given the standard education. Conclusion. The use of the specialized structured program for the education for the groups of the patients with type 1 diabetes mellitus during transition to SAP therapy results not only in a more pronounced improvement of glycemic control indices but also in the positive changes of certain QL characteristics.

An exploratory study of how young people experience and perceive living with type 1 diabetes during late adolescence and emerging adulthood

2019 ◽  
pp. 174239531988648 ◽  
Author(s):  
Marianne Vie Ingersgaard ◽  
Didde Hoeeg ◽  
Ingrid Willaing ◽  
Dan Grabowski
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Young People ◽  
Emerging Adults ◽  
Well Being ◽  
Social Contexts ◽  
Treatment Regimens ◽  
Special Rules ◽  
Uncertain Future

Objective Suboptimal glycemic control and psychosocial challenges are significant concerns for adolescents and emerging adults (collectively young people) with type 1 diabetes. Knowledge about young peoples’ attitudes towards living with type 1 diabetes is inadequate, but the issue is important in the development of strategies to improve glycemic control and psychosocial well-being. This study explored young peoples’ perceptions of living with type 1 diabetes. Methods An exploratory, qualitative design was employed. Data were collected through five participatory workshops with 19 young people (age 15–25). Data were thematically analyzed. Results The overall depiction of living with type 1 diabetes was paradoxical; it affected everything and nothing. Living with type 1 diabetes was a balancing act between accommodating a “normal” way of living and self-management tasks of the treatment regimen. Participants’ perceptions reflected shifting accounts that could be divided into five themes: (1) special rules during youth, (2) striving for autonomy, (3) an uncertain future, (4) social support, and (5) stigma and disclosure. Discussion It is important to probe for the multiple and interrelated social contexts that underlie young peoples’ motives for adhering to and deviating from treatment regimens. Future studies should focus on relational aspects, including stigma mechanisms, the role of friends, and facilitation of balanced parental involvement.

scholarly journals Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Heiko Bratke ◽  
Børge Sivertsen
Keyword(s):  
Quality Of Life ◽  
Type 1 Diabetes ◽  
University Students ◽  
Metabolic Control ◽  
Well Being ◽  
Somatic Health ◽  
Good Metabolic Control ◽  
Health And Well Being

Abstract Objectives To explore mental and somatic health, quality of life, alcohol-related problems, sleep problems, and diabetes related distress in university students with type 1 diabetes (T1D), compared to students without T1D. Further, we evaluated associations with gender, treatment modalities, and achieved metabolic control. Methods All fulltime Norwegian students aged 18–35 years pursuing higher education in 2018 (n=162.512) were invited into a comprehensive national survey on health and well-being. Students that stated having diabetes was asked further questions about their diabetes care. Results Of 49,684 participating students, 324 participants stated having T1D. Students with T1D did not show more mental or somatic health symptoms, or report a higher level of loneliness. However, T1D was significantly associated with lower quality of life (QoL). Students with good metabolic control reached the same QoL as students without T1D. Mental disorders and suicidality were associated with lacking metabolic control. The proportion of unhealthy drinking habits was generally low, and even lower in students with T1D. Sleeping patterns were generally good, but students using continuous glucose measurement were awakening more often during sleep. Females with T1D showed higher levels of diabetes related problems and distress, but good metabolic control was associated with lower diabetes distress level. Conclusions Students with T1D scored equally on most mental and somatic health scales. Their quality of life was significantly worse compared to their healthy peers. Knowledge on the impact of metabolic control, gender and the use of CSII and CGM can be valuable for the caretakers of young adults with T1D.

scholarly journals Metabolic Control of Type 1 Diabetes in Children Treated with Insulin Pump Therapy

2009 ◽  
Vol 9 (2) ◽  
pp. 120-124
Author(s):  
Sniježana Hasanbegović ◽  
Edo Hasanbegović
Keyword(s):  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Insulin Pump ◽  
Vascular Complications ◽  
Insulin Analogues ◽  
Mean Value ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Number Of Patients

In this paper we present study of metabolic control in children suffering from TYPE 1 Diabetes Mellitus (T1DM) who use insulin pump (IP) therapy, and who were treated at Paediatric Clinic in Sarajevo.In retrospective study we followed all T1DM patients with IP therapy introduced in the period from 1st March 2005 to 1st September 2008.We analyzed their age and sex structure, therapy before IP use, and the metabolic control of T1DM represented with glycosylated haemoglobin (HbA1c) value just before and 6 months after IP therapy introducing.The total number of observed patients was 39. There were 24 boys (61,5 %) and 15 girls (38,5 %) with the age range between 12,3 ± 3,2 years. Most patients were from age group 8-14 years. In the same number of patients 17 (43,6 %) diabetes duration was less than 5 years and 5-10 years. Before IP introduction most patient 61,5 % use therapy with insulin analogues. Mean value of HbA1c before IP therapy introduction was 8,57±1,65 % and 6 months after IP therapy introduction HbA1c 7,53 ± 0,81 % (p = 0,0009). There was significant reduction HbA1c values even 6 month after IP therapy introduced.Therapy with IP in children with diabetes was very efficient in achieving therapeutic goal of T1DM treatment (HbA1c<7,0 %) what will protect patients from appearance and progression of chronic micro vascular complications on eyes, kidneys and peripheral nerves.

scholarly journals Renal activity of Akt kinase in experimental Type 1 diabetes

2008 ◽  
pp. 709-716
Author(s):  
J Ždychová ◽  
J Veselá ◽  
L Kazdová ◽  
R Komers
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Metabolic Control ◽  
Insulin Treatment ◽  
Protein Translation ◽  
Kinase Assay ◽  
Akt Kinase ◽  
Cell Functions ◽  
Mtor Activity

Akt kinase regulates numerous cell functions including glucose metabolism, cell growth, survival, protein synthesis, and control of local hemodynamics. mTOR is one of down-stream effectors of Akt involved in the initiation of protein translation. However, renal Akt signaling in Type 1 diabetes (DM) in vivo, in particular under the conditions reflecting differences in metabolic control, has received less attention. Renal cortical activity and expression of Akt and mTOR (kinase assay, western blotting) were determined in streptozotocin-diabetic rats (D) with different levels of glycemic control (blood glucose 22.0±1.0, 13.4±1.5, 8.1±0.4 mmol/l, p<0.05 between the groups), achieved by varying insulin treatment (0, 4 and 12 IU/day), and in control rats with (C4) or without (C) chronic insulin administration. Renal Akt activity was reduced in D rats without insulin treatment and severe hyperglycemia (D-0, -62 %, p<0.01 vs. C), partially restored in moderately hyperglycemic rats (D-4, -30 %, p<0.05 vs. C), and normalized in D rats with intensive insulin and tight metabolic control (D-12). Expression of active mTOR paralleled Akt activity in D-0 (-51 %, p<0.01 vs. C), but not in D-4 and D12 that demonstrated increases in active mTOR (+55 %, +80 % resp., p<0.05) as compared to C. Moreover, insulin activated renal Akt (+82 %, p<0.01), but not mTOR in C4. In conclusion, glycemic control and intensity of insulin treatment are important modulators of renal Akt and mTOR activity in diabetes. While Akt activity is reversible by tight metabolic control, combination of hyperglycemia and insulin treatment resulted in enhancement of mTOR activity. In addition to Akt, other signaling pathways likely contribute to regulation of renal mTOR activity in diabetes.

Modern insulin therapy with insulin analogues detemir and aspart in children and adolescents: The problems and solutions

2013 ◽  
Vol 59 (6) ◽  
pp. 80-86
Author(s):  
T L Kuraeva
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Children And Adolescents ◽  
Human Insulin ◽  
Vascular Complications ◽  
Insulin Analogues ◽  
Diabetic Patients ◽  
Problems And Solutions ◽  
Basal Bolus

DCCT (Diabetes Control and Complications Trial) study showed that intensified insulin therapy associates with significant reduction both of development and progression of vascular complications compared to conventional insulin therapy in type 1 diabetic patients. Modern algorithms of diabetes treatment in children and adolescents reflect the need to achieve and maintenance of glycemic control as closely as possible to normal level. Insulin analogues have improved pharmacokinetic and pharmacodynamic properties, and also have less variability than human insulin. So they have more physiologic and predictable profile actions and, therefore, provide the possibility to achieve optimal glycemic control with low risk of hypoglycemia. Current review demonstrates the benefits of basal-bolus therapy with insulin analogues detemir (Levemir) and aspart (NovoRapid) and advantages of insulin NovoRapid in the continuous subcutaneous insulin infusion (CSII) compared with human insulin in children and adolescents with type 1 diabetes mellitus.

scholarly journals Metabolic control and body mass index in patients with type 1 diabetes on different insulin regimens

2004 ◽  
Vol 4 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Indira Kulenović ◽  
Senija Rasić ◽  
Mirko Grujić
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Body Mass ◽  
Insulin Treatment ◽  
Mean Values ◽  
Intensified Insulin Treatment ◽  
Type 1 Dm

ABSTRACTINTRODUCTION: Without sufficient insulin treatment, acceptable level of glycoregulation, avoidance of dislipoproteinaemia and maintaince of body mass is difficult to achieve in patients with type 1 diabetes mellitus (DM). On the other hand sometimes it is difficult to prevent weight gain, endogenous hyperlipidemia and iatrogenic insulin resistance.AIM: To compare metabolic control indicators in patients with type 1 DM in patients treated conventionally to those on intensified insulin regimen.MATERIAL AND METHODS: A sample of 52 persons with type 1 DM, without late complications and long duration of the disease, was selected. Among them 19 (36.5%) persons were treated with insulin in 4 or 5 doses, and 33 (63.5%) conventionally, in 2 doses. All the participants had biochemical indicators of metabolic control determined (glycosylated Hb, fasting and postprandial glycaemia, total cholesterol, triglycerides as well as lipoprotein fractions, HDLC and LDLC), body height (BH) and weight (BW) measured, body mass index calculated (BMI) and blood pressure measured (BP).RESULTS: In the group treated conventionally we found significantly higher mean values of BMI as compared to those on intensified insulin treatment (23.2 ± 2.0 kg/m2, and 21.2 ± 1.2 kg/m2 respectively, p<0.01) and proportion of those with overweight was as well significantly higher (27.3% versus 0%, p =0.012). We noted higher mean values of systolic (134.2 ± 17.6 mmHg, versus 123.4 ± 12.7. p<0.05) and diastolic (83.2 ± 10.1, versus 74.0 ± 9.7, p<0.01) BP. Biohemical indicators of gly-coregulation were significantly worse with, at the same time, higher total dose of applied insulin (55.9 ± 8.5 IU, versus 46.3 ± 10.0 IU, p <0.01), and insulin units per kg of body weight (0.84 ± 0.11 IU/kg versus 0.77 ± 0.15 IU/kg, p<0.05).CONCLUSION: Results indicate that intensified insulin treatment is more favourable variant of treatment, by which the certain level of insulin resistance, which might be present in patients treated with two higher insulin doses, is probably reduced. Therefore it improves metabolic outputs, blood pressure values and body mass index but also may have beneficial impact to economic aspect of insulin treatment as well.

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