scholarly journals Impact of glycemic variability and the fear of hypoglycemia on type 1 diabetes control

2020 ◽  
Vol 4 (6) ◽  
pp. 324-328
Author(s):  
A.R. Volkova ◽  
◽  
M.E. Chernaya ◽  
V.S. Mozgunova ◽  
M.B. Durdyeva ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Variability ◽  
Diabetes Control ◽  
Target Level ◽  
Fear Of Hypoglycemia ◽  
Group 2 ◽  
Hba1c Target ◽  
Hba1c Levels ◽  
Group 1

Background: currently, the level of HbA1c does not necessarily allow for the understanding of glycemic control. Considering this, glycemic variability (GV) is extensively studied in recent years. Psychological component has a significant impact on GV as the fear of hypoglycemia (FOH) and its consequences can reduce the motivation for achieving target glycemia and HbA1c as well as adherence to treatment.Aim: to assess GV in patients with type 1 diabetes with the elevated and target levels of HbA1c and to analyze the effect of FOH on diabetes control.Patients and Methods: 78 patients with type 1 diabetes who received insulin therapy (multiple daily injections or continuous subcutaneous insulin infusion) were enrolled. All patients were divided into two groups based on HbA1c levels, i.e., group 1 (patients who achieved individual HbA1c target level, n=13) and group 2 (patients who did not achieve individual HbA1c target level, n=65). HbA1c levels and GV were measured in all patients using iPRO™2 Professional CGM system (Medtronic, Ireland). In addition, FOH was evaluated using the Hypoglycemia Fear Survey II (HFS-II).Results: in group 1, time in-range was significantly higher (p=0.013) while daily GV was significantly lower (p=0.023) than in group 2. HbA1c levels, the rate of severe hypoglycemia, and diabetes duration were lower among the patients with lower levels of FOH.Conclusion: studying GV can provide better understanding of diabetes control in patients with any HbA1c level. Optimized treatment strategy using HFS-II can attenuate the effects of frequent hypoglycemia on GV and HbA1c levels and improve treatment efficacy.KEYWORDS: glycemic variability, glycated hemoglobin, diabetes, continuous glucose monitoring, hypoglycemia.FOR CITATION: Volkova A.R., Chernaya M.E., Mozgunova V.S. et al. Impact of glycemic variability and the fear of hypoglycemia on type 1 diabetes control. Russian Medical Inquiry. 2020;4(6):324–328. DOI: 10.32364/2587-6821-2020-4-6-324-328.

THE EFFECT OF CONTINUOUS SUBCUTANEOUS INSULIN INFUSION TREATMENT, INSULIN ANALOG, AND HUMAN INSULIN OF CHILDREN WITH DIABETES

2015 ◽  
Vol 3 ◽  
pp. 432-436
Author(s):  
Elina Petkova ◽  
Valentina Petkova ◽  
Guenka Petrova ◽  
Maya Konstantinova
Keyword(s):  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Human Insulin ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Subcutaneous Insulin ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of this study is to evaluate the cost-effectiveness of  continuous subcutaneous insulin infusion (CSII) to multiple daily insulin injection (MDI) either with analogues or with human insulin, based on the achieved therapeutic results such as changes in glycated hemoglobin level (HbA1c) in the various therapies. The study was performed with children with type-1 diabetes in Bulgaria. The objective of this study was to serve for the Bulgarian National Health Fund (NHIF).Methods: A combined retrospective and prospective study was performed at the Endocrinology diabetes and genetic diseases clinic.51 children with type-1 diabetes were observed for 7 months diveded into three group: Group 1- on continuous subcutaneous insulin infusion (CSII); Group 2- on multiple daily insulin analogues injections (MDI) and Group 3 – on human insulin (HI).Patient demographic data, age, sex, weight, duration of disease, HbA1c – values before the start of the study and after the end of the observation and type of treatment (CSII; MDI or HI) were observed. Cost-effectiveness, sensitivity and statistical analyses are applied to studied long-term therapeutic results.Results: The three groups of observed children do not differ statistically in age and gender. Most of the participants in Group 1 and Group 2 have suffered from diabetes from 5,6 years. The duration of diabetes was lower in the group of human insulin. All studied children are treated. By all of them the results of the treatment improved, but in the Group 1 the improvement of HbA1c is the highest. The average improvement of HbA1c in the Group 1 after the CSII introduction is 1.85, while after the application of analogue insulin is 0,59 and 0,28 respectively in the Group 3 after the treatment on human insulin.The cost of insulin pump, consumables- infusion set and insulin reservoir, blood glucose monitoring system, strips, needles and insulin cost was calculated.The total cost ot the treatment of diabetes with insulin pump for 7 months is 2358,85Euro; 856,98 Euro in the Group 2 on MDI and 744,24 Euro for 7 months in the Group 3 on human insulin.The differences in costs and therapeutic results permit to conduct cost- effectiveness analysis by comparing of the three alternatives.Our study shows that the CSII pumps allows better diabetes control compared to the treatment with analogue insulin and human insulin. Insulin pumps are also cost- effectiveness alternative for children with type 1 diabetes.

scholarly journals Analysis of indicators of daily blood pressure profile in patients wi th type 1 diabetes, depending on the course of the disease

2018 ◽  
Vol 23 (4) ◽  
pp. 301-308
Author(s):  
N.O. Pertseva ◽  
K.I. Moshenets
Keyword(s):  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Pressure Profile ◽  
Healthy Controls ◽  
Area Index ◽  
Time Index ◽  
Blood Pressure Profile ◽  
Group 2 ◽  
Group 1

The aim: to study the features of daily profile and circadian rhythm of blood pressure (BP) in groups of patients with type 1 diabetes mellitus (T1DM), depending on glycemic control. Materials and methods: 63 patients with T1DM, age: 18-45 years without hypertension were examined. Patients were divided into groups: Group 1 — HbA1c≤7.0% (n=21), Group 2 — HbA1c>7.0% (n=42). 10 sex- and agematched healthy controls were included. Results: Patients with T1DM had a significantly higher pulsatile blood pressure (PBP) per night, higher daily systolic blood pressure (SBP) variability, compared with healthy controls, and significantly higher daily SBP area index (SPAI24), daily SBP time index (SPTI24), daily diastolic blood pressure (DBP) area index (DPAI24), daily DBP time index (DPTI24). The double product (DP) was higher in patients with T1DM in the daytime and within 24 hours compared to control (p=0.002) and (p=0.001) respectively. Pathological profiles of daily blood pressure were found. In group 1, according to the dipping in SBP 28.57% of patients were non-dippers, 4.76% were extreme dippers. In group 2, the non-dipper profile had 33.33%, the reverse dipper had 2.38%, and extreme dipper had 11.90% of patients. According to the dipping in DBP: in group 1 33.33% were non-dippers, and 9.53% were extreme dippers. In group 2 non-dippers — 19.04%, extreme dippers — 2.38%, extreme dippers — 38.10%. HbA1c directly correlates with: (DPAI24) (ρ=0,301; р=0,014), DPAI night (ρ=0,292; р=0,010), DPTI24 (ρ=0.292; p=0.012), DPTI night (ρ=0.268; p=0.018). Conclusions. The daily blood pressure profile in patients with T1DM without arterial hypertension is characterized by insufficient decrease in BP at night, an increase in the average daily DBP, PBP, as well as DPAI24, DPTI24, DP and the variability of the average daily SBP. Poor glucose control led to led to an increase in hemodynamic load. It is the risk factor cardiovascular complications in patients with T1DM.

scholarly journals Clinical characteristics of gastroesophageal reflux disease in adolescents with diabetic cardiac autonomic neuropathy

2014 ◽  
Vol 17 (4) ◽  
pp. 93-98
Author(s):  
Sergey Evgen'evich Kostyakov ◽  
Irina Leonidovna Alimova
Keyword(s):  
Type 1 Diabetes ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Autonomic Neuropathy ◽  
Acid Reflux ◽  
Diabetic Autonomic Neuropathy ◽  
Night Time ◽  
Group 2 ◽  
Group 1

Aim. We evaluated the clinical and functional characteristics of gastroesophageal reflux disease (GERD) in adolescents with a cardiac form of diabetic autonomic neuropathy. Patients and methods. Fifty-two adolescents, aged 12?17 years, with type 1 diabetes were studied. Patients were divided into two groups according to the results of two autonomic tests (cardiointervalography and Valsalva test). Group 1 included 14 adolescents with a cardiac form of diabetic autonomic neuropathy. Group 2 included 38 controls. Oesophageal pH parameters were monitored over 24 h using a Gastroscan-24. The 24-h period was divided into day-time (08:00?22:00) and night-time (22:00?08:00) periods to eliminate the influence of exogenous factors (such as eating, physical activity and change of body position) on the oesophageal kinetic function. Results. Pathological gastroesophageal reflux occurred more frequently in Group 1 (78.5%) than in Group 2 (36.8%; p=0.018). Heartburn was experienced by 14.3% of the patients in Group 1 and generally occurred with similar frequency in the two groups (p=0.91). The daily amount of pathological acid reflux in Group 1 (86 [62?141]) was higher versus Group 2 (52.5 [24?108]; p=0.047) that was associated with night-time reflux in Group 1. A correlation analysis demonstrated the increase of frequency and intensity of the acid reflux due to development of parasympathetic insufficiency. Conclusion. Diabetic autonomic neuropathy in adolescents with type 1 diabetes appears to be a significant risk factor for the development of pathological subclinical GERD with altered daily pattern.

scholarly journals Microvascular reactivity in type 1 diabetics

2009 ◽  
Vol 53 (6) ◽  
pp. 741-746 ◽  
Author(s):  
Tereza Cristina Abi-Chahin ◽  
Moema de Alencar Hausen ◽  
Claudia Moraes Mansano-Marques ◽  
Vera Lucia Rabello de Castro Halfoun
Keyword(s):  
Type 1 Diabetes ◽  
Vascular Reactivity ◽  
Reactive Hyperemia ◽  
Basal Area ◽  
Diabetic Patients ◽  
Transverse Segment ◽  
Group 2 ◽  
Mean Differences ◽  
Group 1

OBJECTIVE: To evaluate whether differences are present in microvascular response to the schemia induced by dynamic videocapillaroscopy (VCD), through analysis of the measured capillar transverse segment area (CTSA) in patients with type 1 diabetes mellitus (T1DM). METHODS: The vascular reactivity of the CTSA was studied by VCD, using a reactive hyperemia test in 61 volunteers, being 31 healthy controls without diabetes family history (Group 1) and 30 patients with T1DM without complications (Group 2). The images were captured every two seconds, during reperfusion after one minute induced ischaemia, and they were analyzed by the program Studio Version 8 and Motic Image Plus. The pre-ischemia capillary transverse segment (basal area, BA), the maximum strain post-ischemia (maximum area, MA), and time to achieve it (MAt) were measured during reperfusion, and the increased area percentage (Ap) was estimated. RESULTS: The mean differences between groups were evaluated by the t-test. The median comparisons between the groups were studied by the Mann-Whitney test. There was no difference in BA between the groups. The Ap was significantly lower among the diabetic patients, and there was a significant increase in the Mat among the patients of Group 2 when compared to Group 1. CONCLUSIONS: These data suggest that type 1 diabetes provokes earlier endothelial dysfunction, before the onset of clinically detectable degenerative complications. The outcomes from these alterations need further studies.

scholarly journals Self-reported psychological disorders among the mothers of children with autism spectrum disorder, type 1 diabetes mellitus, and typically developed children

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ahmed Malalla Al Ansari ◽  
Mohamed Ismael Janahi ◽  
Abdulrahman J. AlTourah ◽  
Haitham Ali Jahrami ◽  
Mansour Bin Rajab
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Geographical Area ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Control Group ◽  
Management Plans ◽  
Group 2 ◽  
Group 1

Abstract Background To assess the prevalence of symptoms of depression, anxiety, and stress among mothers of children with autism spectrum disorders (ASD), type 1 diabetes (DM), and typical development (TD), in a geographical area where such data are lacking Method A descriptive study with the three groups of parents of children with and without a condition was conducted (ASD n=126, group 1; DM n=43, group 2; and TD n= 116, comparative group). Measures of depression, anxiety, and stress were collected to examine the prevalence of factors, difference between groups, and their association with demographic characteristics. Results On the DASS-21, both groups 1 and 2 had higher mean scores for depression (37.86), anxiety (4.58), and stress (29.81) than the control group (P=0.015). On the PSS-14, the mean score was higher in group 2 (28.63) than in group 1 (27.61) and the comparison group (25.87) (P=0.004). On the DASS 21, group 1 scored higher in the depression domain (P=0.046), whereas group 2 scored higher in the anxiety domain (P=0.034) and stress domain (P=0.009) than the TD group. Conclusion Mothers of children with ASD should be assessed for the presence of depression following diagnosis. Mothers of children with type 1 diabetes require careful monitoring for the effects of anxiety and stress on their mental health and therefore their ability to cope with diabetes management plans. Trial registration Not applicable.

scholarly journals The level of antibodies to pneumococcal vaccine in children and adolescents with type 1 diabetes

2009 ◽  
Vol 55 (3) ◽  
pp. 17-20 ◽  
Author(s):  
M P Kostinov ◽  
T V Skochilova ◽  
A A Tarasova ◽  
V A Vorob'eva ◽  
T I Korovkina ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Pneumococcal Vaccine ◽  
Baseline Level ◽  
Subunit Vaccine ◽  
Protective Level ◽  
Baseline Levels ◽  
Group 2 ◽  
Group 1

The trend in the formation of postvaccinal antibodies (Ab) to a mixture of S. pneumoniae polysaccharides (PS) was studied in 100 Pneumo 23-vaccinated children and adolescents with type 1 diabetic (T1D) (Group 1, n = 72) and its combination with the subunit vaccine Grippol (Group 2, n = 28). Following 1-1.5 months, the protective level of Ab l 40 conventional units (CU/ml) was revealed in 95.1 and 85.2% of Groups 1 and 2, respectively; and after 1 year, this was in 55.1 and 37%, respectively (p > 0.05). The level of formation of IgG Ab to a PS mixture did not depend on the age of patients, the duration of T1D, the presence of late diabetic complications. A relationship was found between the formation of postvaccinal Ab and their baseline level: in patients with very low (< 10 CU/ml) and low (10-20 CU/ml) levels of Ab after administration of pneumococcal vaccine, the level of IgG Ab to a S. pneumoniae PS mixture increased by 8.8-4.1 times in the early periods and exceeded the baseline levels by 4.8-2.8 times, respectively. The putative protective level of IgG AB to a S. pneumoniae PS mixture is proposed to be l 20 CU/ml.

scholarly journals 1020 Sleep and Glycemic Control in Adults With Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A387-A388
Author(s):  
S K Malone ◽  
A J Peleckis ◽  
A I Pack ◽  
N Perez ◽  
G Yu ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Sleep Onset ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Sleep Efficiency ◽  
Hypoglycemia Unawareness ◽  
Time In Bed ◽  
Hba1c Levels

Abstract Introduction Nocturnal hypoglycemia is life threatening for individuals with type 1 diabetes (T1D) due to loss of hypoglycemia symptom recognition (hypoglycemia unawareness) and impaired glucose counterregulation. These individuals also show disturbed sleep, which may result from glycemic dysregulation. Whether use of a hybrid closed loop (HCL) insulin delivery system with integrated continuous glucose monitoring (CGM) designed for improving glycemic control, relates to better sleep across time in this population remains unknown. Methods Six adults (median age=58y,T1D duration=41y) participated in an 18-month ongoing clinical trial assessing the effectiveness of an HCL system. Sleep and glycemic control were measured concurrently using wrist actigraphs and CGM at baseline (1 week) and months 3 and 6 (3 weeks) following HCL initiation. BMI and hemoglobin A1c (HbA1c) were collected at all timepoints. Spearman’s correlations modeled associations between sleep, BMI, and glycemic control at each time point. Repeated ANOVAs modeled sleep and glycemic control changes from baseline to 3 months and to 6 months. Results Sleep and glycemic control indices showed significant associations at baseline and 3 months. More time-in-bed and later sleep offset related to higher HbA1c levels at baseline. Later sleep onset, midpoint and offset, and greater sleep efficiency associated with greater %time with hyperglycemia (glucose &gt;180 mg/dL) or hypoglycemia (glucose &lt;70 mg/dL) at baseline and 3 months. Longer sleep duration and greater sleep efficiency related to greater %time with hyperglycemia at 3 months. At 3 months, more wake after sleep onset associated with lower HbA1c levels and longer nocturnal awakenings and more sleep fragmentation associated with less glycemic variability. While both sleep and glycemic control improved from baseline to 3 and 6 months, these were not statistically significant. Conclusion Various dimensions of actigraphic sleep related to concurrently estimated glycemic indices indicative of poorer glycemic control and HbA1c across time in adults with long-standing T1D and hypoglycemia unawareness. Support This work was supported by NIH R01DK117488 (NG), R01DK091331 (MRR), and K99NR017416 (SKM).

scholarly journals Self-reported psychological disorders among the mothers of children with an autism spectrum disorder, type 1 diabetes mellitus, and typically developed children

2020 ◽  
Author(s):  
Ahmed Malalla Al-Ansari ◽  
Mohammed Ismail Janahi ◽  
Abdulrahman Jamal AlTourah ◽  
Haitham Ali Jahrami ◽  
Mansour Bin Rajab
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Management Plan ◽  
Autism Spectrum ◽  
Control Group ◽  
Diabetes Mellitus Group ◽  
Children With Asd ◽  
Group 2 ◽  
Group 1

Abstract ObjectivesTo assess the prevalence of symptoms of depression, anxiety, and stress among mothers of children of autism spectrum disorders (ASD), type 1 diabetes, and typically developed (TD).Method. The study sample comprised mothers of children with ASD ( Group 1; n = 116), diabetes mellitus (Group 2; n = 43 ), and a control group of mothers with TD children.ResultsBoth groups 1 and 2 had higher scores of depression (37.86), anxiety (4.58), and stress (29.81) in DASS-21 in comparison to control (P = 0.015). On PSS-14 The mean score on PSS-14 were: group 1 (27.61), group 2 (28.63) and control (25.87) (p = 0.004). Group 1 scored higher scores for depression domain (p = 0.046) whereas group 2 for anxiety domain (p = 0.034) and stress domain (p = 0.009) in comparison to TD group on DASS-21.ConclusionMothers of children with ASD should be assessed for the presence of depression following diagnosis. Mothers of children with type 1 diabetes required careful monitoring for the effects of anxiety and stress on their mental health, therefore their ability to cope with a management plan.

scholarly journals Achieving the HbA1c Target Requires Longer Time in Range in Pregnant Women with Type 1 Diabetes

2021 ◽  
Author(s):  
Ping Ling ◽  
Daizhi Yang ◽  
Nan Gu ◽  
Xinhua Xiao ◽  
Jing Lu ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pregnant Women ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Pregnancy And Postpartum ◽  
Best Fitting ◽  
Time In Range ◽  
Hba1c Target ◽  
Mean Glucose

Abstract Aims Continuous glucose monitoring (CGM) overcomes the limitations of glycated hemoglobin (HbA1c). This study was to investigate the relationship between CGM metrics and laboratory HbA1c in pregnant women with type 1 diabetes. Methods An observational study enrolled pregnant women with type 1 diabetes who wore CGM devices during pregnancy and postpartum from 11 hospitals in China from January 2015 to June 2019. CGM data were collected to calculate time-in-range (TIR), time above range (TAR), time below range (TBR), and glycemic variability parameters. Relationships between the CGM metrics and HbA1c were explored. Linear and curvilinear regressions were conducted to investigate the best-fitting model to clarify the influence of HbA1c on the TIR-HbA1c relationship during pregnancy. Results A total of 272 CGM data and corresponding HbA1c from 98 pregnant women with type 1 diabetes and their clinical characteristics were analyzed in this study. Mean HbA1c and TIR were 6.49±1.29% and 76.16±17.97% during pregnancy, respectively. HbA1c was moderately correlated with TIR 3.5-7.8(R= -0.429, P=0.001), mean glucose (R= 0.405, P=0.001) and TAR 7.8 (R=0.435, P=0.001), but was weakly correlated with TBR 3.5 (R=0.034, P=0.001) during pregnancy. On average, a 1% (11 mmol/mol) decrease in HbA1c corresponded to an 8.5% increase in TIR 3.5-7.8. During pregnancy, HbA1c of 6.0%, 6.5% and 7.0% were equivalent to a TIR 3.5-7.8 of 78%, 74%, and 69%, respectively. Conclusions We found that there was a moderate correlation between HbA1c and TIR 3.5-7.8 during pregnancy. To achieve the HbA1c target &lt;6.0%, pregnant women with type 1 diabetes should strive for TIR 3.5-7.8 &gt;78% (18h 43min) during pregnancy.

Sign in / Sign up

Export Citation Format

Share Document