Influence of Metabolic Control on Splanchnic Glucose Uptake, Insulin Sensitivity, and the Time Required for Glucose Absorption in Patients With Type 1 Diabetes

OBJECTIVE: Metabolic control often deteriorates during puberty in children with type 1 diabetes. The aim of the present study was to investigate whether addition of metformin for 3 Months improves metabolic control and insulin sensitivity. DESIGN: Twenty-six of 30 randomised adolescents with type 1 diabetes (18 females, eight males) completed a double-blind placebo-controlled trial. Their mean age was 16.9+/-1.6 (s.d.) Years, mean glycated haemoglobin (HbA(1c)) 9.5+/-1.1% and daily insulin dosage 1.2+/-0.3 U/kg. The participants were randomised to receive oral metformin or placebo for 3 Months. HbA(1c) was measured Monthly, and peripheral insulin sensitivity was assessed by a euglycaemic hyperinsulinaemic clamp at baseline and at the end of the study. RESULTS: HbA(1c) decreased significantly in the group treated with metformin, from 9.6 to 8.7% (P<0.05), but was unchanged in the placebo group (9.5 vs 9.2%). Peripheral glucose uptake divided by mean plasma insulin concentration was increased in the metformin group (P<0.05) but not in the placebo group. Initial insulin sensitivity was inversely correlated to changes in HbA(1c) (r=-0.62; P<0.05) and positively correlated to changes in insulin sensitivity (r=0.77; P<0.01). CONCLUSIONS: In this double-blind placebo-controlled study we found that metformin improves metabolic control in adolescents with type 1 diabetes. The effect seems to be associated with an increased insulin-induced glucose uptake.

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Effects of Growth Hormone and Free Fatty Acids on Insulin Sensitivity in Patients with Type 1 Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-0378 ◽

2009 ◽

Vol 94 (9) ◽

pp. 3297-3305 ◽

Cited By ~ 13

Author(s):

Burak Salgin ◽

Maria L. Marcovecchio ◽

Rachel M. Williams ◽

Sarah J. Jackson ◽

Leslie J. Bluck ◽

...

Keyword(s):

Insulin Resistance ◽

Fatty Acids ◽

Growth Hormone ◽

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Glucose Uptake ◽

Glucose Production ◽

Endogenous Glucose Production ◽

Endogenous Glucose

Context: Because GH stimulates lipolysis, an increase in circulating free fatty acid levels, as opposed to a direct effect of high GH levels, could underlie the development of insulin resistance in type 1 diabetes (T1D). Our aim was to explore the relative contributions of GH and free fatty acids to the development of insulin resistance in patients with T1D. Patients: Seven (four females, three males) nonobese patients with T1D aged 21–30 yr were studied on four occasions in random order. On each visit, overnight endogenous GH production was suppressed by octreotide. Three 1-h pulses of recombinant human GH (rhGH) or placebo were administered on two visits each. Acipimox, an antilipolytic drug, or a placebo were ingested every 4 h on two visits each. Stable glucose and glycerol isotopes were used to assess glucose and glycerol turnover. The overnight protocol was concluded by a two-step hyperinsulinemic euglycemic clamp on each visit. Main Outcome: rhGH administration led to increases in the insulin infusion rate required to maintain euglycemia overnight (P = 0.008), elevated basal endogenous glucose production (P = 0.007), decreased basal peripheral glucose uptake (P = 0.03), and reduced glucose uptake during step 1 of the clamp (P < 0.0001). Coadministration of rhGH and acipimox reversed these effects and suppression of lipolysis in the absence of GH replacement led to further increases in insulin sensitivity. Results: GH pulses were associated with an increase in endogenous glucose production and decreased rates of peripheral glucose uptake, which was entirely reversed by acipimox. Therefore, GH-driven decreases in insulin sensitivity are mainly determined by the effect of GH on lipolysis. Growth hormone decreases insulin sensitivity through increases in free fatty acid levels.

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Physical Activity, Insulin Sensitivity, and Metabolic Control in Type 1 Diabetes Mellitus

Turkish Journal of Endocrinology and Metabolism ◽

10.25179/tjem.2018-61916 ◽

2019 ◽

Vol 23 (1) ◽

pp. 8-18

Author(s):

Nizameddin KOCA ◽

Metin GÜÇLÜ ◽

İrfan ESEN ◽

Gamze EMLEK ◽

Sinem KIYICI ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Type 1 Diabetes Mellitus ◽

Metabolic Control

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Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes

Hormone Research in Paediatrics ◽

10.1159/000484896 ◽

2017 ◽

Vol 89 (2) ◽

pp. 73-81 ◽

Cited By ~ 2

Author(s):

Christina Reinauer ◽

Thomas Reinehr ◽

Christina Baechle ◽

Beate Karges ◽

Julia Seyfarth ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Metabolic Control ◽

Multiple Testing ◽

Fetuin A ◽

Insulin Requirements ◽

The Metabolic Syndrome ◽

Relevant Effect ◽

The Relationship

Background and Aim: The hepatokine fetuin A is upregulated in the metabolic syndrome and in type 2 diabetes (T2D), while its role in adolescent type 1 diabetes (T1D) is unclear. We assessed the relationship between circulating fetuin A levels and metabolic control, comorbidities, and complications in adolescent T1D patients. Methods: We studied the relationship between serum fetuin A and clinical diabetes-related data from the DPV registry (Diabetes-Patienten-Verlaufsdokumentation) in 172 adolescent T1D patients with early-onset (<5 years) long-standing (>10 years) T1D. Fetuin A levels were further compared between adolescent T1D and T2D patients. Results: Serum fetuin A levels in T1D patients (mean 0.267 ± 0.043 g/L) did not correlate with age, diabetes duration, gender, body mass index (BMI), glycated hemoglobin, serum lipid levels, blood pressure, celiac or thyroid disease, nephropathy, or retinopathy. An association of fetuin A levels with insulin requirements was only evident within the subgroup of overweight T1D patients (rs = 0.439, p = 0.028, n = 25, BMI >90th percentile), disappearing after adjustment for multiple testing. Adolescent T1D patients showed distinctly lower fetuin A levels than patients with T2D (p ≤ 0.001). Conclusion: Overall, we did not observe a clinically relevant association of fetuin A levels with surrogate parameters for insulin sensitivity in our juvenile T1D cohort. A correlation with insulin requirements was detectable in overweight patients only. We hypothesize that multiple factors, such as obesity, puberty, inadequate metabolic control, and hepatic steatosis, have to add up before a clinically relevant effect of fetuin A on insulin sensitivity becomes evident.

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Revolutionising type 1 diabetes metabolic control in pregnancy

Endocrine Abstracts ◽

10.1530/endoabs.38.s8.1 ◽

2015 ◽

Author(s):

Helen Murphy ◽

Zoe Stewart ◽

Roman Hovorka

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

In Pregnancy

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The impact of real-time continuous glucose monitoring on metabolic control in children with type 1 diabetes

Endocrine Abstracts ◽

10.1530/endoabs.70.aep447 ◽

2020 ◽

Author(s):

Ruxandra Calapod Ioana ◽

Irina Bojoga ◽

Duta Simona Gabriela ◽

Ana-Maria Stancu ◽

Amalia Arhire ◽

...

Keyword(s):

Type 1 Diabetes ◽

Real Time ◽

Metabolic Control ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

The Impact

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1054-P: Insulin Sensitivity from Sensor and Pump Data in Youths with Type 1 Diabetes: Hybrid Closed-Loop Validation

Diabetes ◽

10.2337/db19-1054-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1054-P

Author(s):

MICHELE SCHIAVON ◽

ALFONSO GALDERISI ◽

KRISTEN A. KRAEMER ◽

CLAUDIO COBELLI ◽

CHIARA DALLA MAN ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Closed Loop

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1217-P: Improvement of Metabolic Control in Type 1 Diabetes after Transition Is Independent from Referral Center and Insulin Regimen

Diabetes ◽

10.2337/db20-1217-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1217-P

Author(s):

SILVIA PIERALICE ◽

ERNESTO MADDALONI ◽

CHIARA MORETTI ◽

ANNA RITA MAURIZI ◽

CARMEN MIGNOGNA ◽

...

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

Insulin Regimen ◽

Referral Center

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ADHD should be considered in adolescents with type 1 diabetes and poor metabolic control

Diabetologia ◽

10.1007/s00125-021-05493-5 ◽

2021 ◽

Author(s):

Charlotte Nylander ◽

Elisabeth Fernell

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

Poor Metabolic Control

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Prevalence of dental caries in children and adolescents with type 1 diabetes: a systematic review and meta-analysis

BMC Oral Health ◽

10.1186/s12903-019-0903-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yan Wang ◽

Lin Xing ◽

Hui Yu ◽

LiJuan Zhao

Keyword(s):

Type 1 Diabetes ◽

Dental Caries ◽

Children And Adolescents ◽

Metabolic Control ◽

Meta Analysis ◽

Preventive Treatment ◽

Diabetic Patients ◽

China National Knowledge Infrastructure ◽

Pooled Prevalence

Abstract Background Dental caries and type 1 diabetes are responsible for a large burden of global disease; however, the exact prevalence of dental caries among children and adolescents with type 1 diabetes remains controversial, and no quantitative meta-analysis exists. Thus, we performed a meta-analysis to evaluate the prevalence of dental caries among children and adolescents with type 1 diabetes. Methods We performed a systematic search strategy using PubMed, EMBASE and China National Knowledge Infrastructure for relevant studies investigating the prevalence of dental caries in children and adolescents with type 1 diabetes from July 1971 until December 2018. The pooled prevalence with 95% confidence intervals (95%CIs) and subgroup analyses were calculated using a random effects model. Results After screening 358 non-duplicated articles, a total of 10 articles involving 538 individuals were included. The overall prevalence of dental caries among children and adolescents with type 1 diabetes was 67% (95% CI: 0.56–0.77%; I2 = 83%). The prevalence was highest in South America (84%) and lowest in diabetic patients with good metabolic control (47%). Conclusions The prevalence of dental caries was high among children and adolescents with type 1 diabetes. Screening and preventive treatment should be included in dental clinical routines for diabetic children and adolescents, especially in those with poor metabolic control.

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