scholarly journals Can the AHCL System Be Used in T1D Patients with Borderline TDDI? A Case Report

Sensors ◽  
2021 ◽  
Vol 21 (21) ◽  
pp. 7195
Author(s):  
Anna Tekielak ◽  
Sebastian Seget ◽  
Ewa Rusak ◽  
Przemysława Jarosz-Chobot
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
Total Daily Dose ◽  
Daily Insulin ◽  
Automatic Mode ◽  
Remission Phase ◽  
Daily Insulin Requirement

(1) Background: Intensive insulin therapy using continuous subcutaneous insulin infusion (CSII) with continuous real-time glucose monitoring (rt CGM) is the best option for patients with T1D. The recent introduction of a technology called Advanced Hybrid Closed Loop (AHCL) represents a new era in the treatment of type 1 diabetes, the next step towards better care, as well as improving the effectiveness and safety of therapy. The aim is to present the case of a T1D patient with a borderline total daily dose of insulin being treated with the Medtronic AHCL system in automatic mode. (2) Materials and Methods: A 9-year-old boy, from October 2020, with type 1 diabetes in remission was connected to the Minimed™ 780G (AHCL) system in accordance with the manufacturer’s recommendations (daily insulin dose > 8 units, age > 7). Records of the patient’s history were collected from visits to The Department of Children’s Diabetology, as well as from the Medtronic CareLink™ software and the DPV SWEET program from October 2020 to April 2021. (3) Results: The patient’s total daily insulin requirement decreased in the first 6 weeks after the AHCL was connected, which may reflect the remission phase (tight glycemic control with a healthy lifestyle). The lowest daily insulin requirement of 5.7 units was also recorded. In a three-month follow-up of the patient treated with AHCL, it was found that for almost 38% of the days the insulin dose was less than 8 IU. (4) Conclusions: The AHCL system allows safe and effective insulin therapy in automatic mode, as well as in patients with a lower daily insulin requirement. The AHCL system should be considered a good therapeutic option for patients from the onset of T1D, as well in the remission phase.

scholarly journals Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes

2020 ◽  
Vol 17 (13) ◽  
pp. 4801
Author(s):  
Stefano Passanisi ◽  
Giuseppina Salzano ◽  
Albino Gasbarro ◽  
Valentina Urzì Brancati ◽  
Matilde Mondio ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Clinical Remission ◽  
Ph Value ◽  
Insulin Requirement ◽  
Newly Diagnosed ◽  
Daily Insulin ◽  
Endogenous Insulin ◽  
Remission Phase ◽  
Daily Insulin Requirement

Partial clinical remission (PCR) is a transitory period characterized by the residual endogenous insulin secretion following type 1 diabetes (T1D) diagnosis and introducing the insulin therapy. Scientific interest in PCR has been recently increasing, as this phase could be crucial to preserve functional beta cells after T1D onset, also taking advantage of new therapeutic opportunities. The aim of this study was to assess the frequency, duration and associated factors of PCR in children newly diagnosed with T1D. Our cohort study included 167 pediatric patients aged 13.8 ± 4.1 years. The association of clinical and laboratory factors with the occurrence and duration of PCR was evaluated via logistic regression and multivariable generalized linear model, respectively. PCR occurred in 63.5% of the examined patients. Patients who achieved the remission phase were significantly older, and they had lower daily insulin requirement compared with non-remitters. PCR was positively associated to body mass index (OR = 1.11; p = 0.032), pH value (OR 49.02; p = 0.003) and c-peptide levels (OR 12.8; p = 0.002). The average duration of PCR was 13.4 months, and older age at diagnosis was the only predictor factor. Two years after diagnosis remitter patients had lower HbA1c and daily insulin requirement.

Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emine Ayça Cimbek ◽  
Aydın Bozkır ◽  
Deniz Usta ◽  
Nazım Ercüment Beyhun ◽  
Ayşenur Ökten ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Partial Remission ◽  
Hemoglobin A1c ◽  
Insulin Dose ◽  
Age At Onset ◽  
Insulin Requirement ◽  
C Peptide ◽  
Factors Associated ◽  
Daily Insulin

Abstract Objectives Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. Methods This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of ≤9. Results Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 ± 0.12 vs. 7.23 ± 0.15, p=0.003), higher C-peptide levels (0.45 ± 0.31 ng/mL vs. 0.3 ± 0.22, p=0.003), and they were significantly older (9.3 ± 3.6 years vs. 7.3 ± 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 ± 0.14 vs. 0.4 ± 0.17 U/kg/day, p=0.014). Conclusions Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.

scholarly journals Basal Insulin Requirement Is  30% of the Total Daily Insulin Dose in Type 1 Diabetic Patients Who Use the Insulin Pump

Diabetes Care ◽  
2011 ◽  
Vol 34 (5) ◽  
pp. 1089-1090 ◽  
Author(s):  
A. Kuroda ◽  
H. Kaneto ◽  
T. Yasuda ◽  
M. Matsuhisa ◽  
K. Miyashita ◽  
...  
Keyword(s):  
Basal Insulin ◽  
Insulin Pump ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
Diabetic Patients ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Type 1 Diabetic Patients

Metformin and Insulin: Is There a Role for Combination Therapy?

1997 ◽  
Vol 31 (4) ◽  
pp. 474-480 ◽  
Author(s):  
Jacqueline R Daniel ◽  
Kathleen O Hagmeyer
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Combination Therapy ◽  
Insulin Therapy ◽  
Insulin Dose ◽  
Insulin Requirements ◽  
Study Selection ◽  
Combined Use ◽  
Bibliographic Search

Objective To review the literature on concomitant insulin and metformin therapy in patients with type 1 diabetes to determine the potential for combination therapy. Data Sources A MEDLINE and bibliographic search (1966–1996) of the literature pertaining to metformin and phenformin and their combined use with insulin in the treatment of patients with type 1 diabetes mellitus was performed. Study Selection All human studies using metformin with insulin were included in the analysis. Studies using phenformin with insulin were also included due to its similarities to metformin. Data Synthesis The recent availability of metformin provides some new options for treating diabetes mellitus. One possibility is the use of this medication in conjunction with insulin in patients with type 1 diabetes. Although this seems like a potentially beneficial combination, there is currently no recommendation for use in this manner. Experience with combination metformin and insulin therapy has consistently demonstrated a reduction in insulin requirements. Studies have not been of necessary size or duration to definitively prove the benefits of this insulin dose reduction or any other benefits of combination therapy. Conclusions When metformin is added to insulin therapy, insulin requirements are likely to decrease. Although one would anticipate benefits from reduction in circulating insulin concentrations, the studies do not provide data to determine if benefits of combination therapy outweigh risks. Further studies of larger size and longer duration are needed before the use of metformin with insulin can be routinely recommended in patients with type 1 diabetes.

scholarly journals Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of <0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of ≤9 for the detection of partial clinical remission

2017 ◽  
Vol 30 (8) ◽  
Author(s):  
Rachel L. Lundberg ◽  
Katherine R. Marino ◽  
Aastha Jasrotia ◽  
Louise S. Maranda ◽  
Bruce A. Barton ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Gold Standard ◽  
Clinical Remission ◽  
Insulin Dose ◽  
Standard Test ◽  
Total Daily Dose ◽  
Gold Standard Test ◽  
Daily Dose ◽  
New Onset

AbstractBackground:It is unclear whether the gold standard test for the detection of partial clinical remission (PCR) in new-onset type 1 diabetes (T1D), the insulin-dose adjusted Hemoglobin AMethods:A retrospective analysis of 204 subjects of ages 2–14 years, mean age 7.9±3.2 years, (male 7.8±3.4 years, [n=98]; female 7.9±3.0 years, [n=106], p=0.816) with new-onset T1D. Anthropometric and biochemical data were collected for the first 36 months of disease. PCR was defined by both IDAAResults:There were 86 (42.2%) (age 9.1±3.0 years; male 57%) remitters by IDAAConclusions:There were no significant differences in the number of remitters, duration of PCR, or the time of peak remission defined by IDAA

scholarly journals SAT-662 Effects of SGLT Inhibitors or GLP1 Analogues on Glucose Homeostasis and Body Weight in Patients with Type 1 Diabetes: A Network Meta-Analysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Soo Lim ◽  
Kim Yoon Ji
Keyword(s):  
Type 1 Diabetes ◽  
Body Weight ◽  
Meta Analysis ◽  
Insulin Dose ◽  
Mixed Treatment Comparison ◽  
Treatment Comparison ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Comparison Results

Abstract Objective: Despite intensive insulin treatment in patients with type 1 diabetes (T1D), many of them do not reach the glycemic target goal. We performed a network meta-analysis to evaluate the efficacy and safety of additional therapy to insulin in patients with T1D. Methods: We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded from January 1970 until September 2019 to identify randomized controlled trials (RCTs) in T1D patients treated with insulin and metformin, sodium-glucose cotransporter (SGLT) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1 RAs). We performed direct and indirect network meta-analysis using Bayesian models and generated rankings of the different hypoglycemia agents by generating mixed treatment comparison. Results: With 23 RCTs (n = 5,151), we performed the network meta-analysis using eight groups; 1) insulin alone, 2) insulin and metformin, 3) insulin and canagliflozin, 4) insulin and dapagliflozin, 5) insulin and empagliflozin, 6) insulin and sotagliflozin, 7) insulin and liraglutide, and 8) insulin and exenatide. Compared with insulin alone, HbA1c was significantly lower in the group treated with insulin and sotagliflozin (mean difference: -0.43%; 95% credible intervals: -0.62 to -0.23). Total daily insulin dose was significantly lower in the insulin and sotagliflozin group by 6.3 U/day than in insulin alone group. Compared with insulin alone, body weight was significantly decreased in the group treated with canagliflozin by 4.5kg, sotagliflozin by 2.8kg, and exenatide by 5.1 kg, respectively. Severe hypoglycemic episodes did not differ between the groups. Conclusions: In patients with T1D, sotagliflozin add-on to insulin decreased HbA1c levels, daily insulin dose, and body weight without hypoglycemia compared to insulin monotherapy. Combined treatment of canagliflozin or exenatide with insulin was effective in weight loss compared with insulin alone in these patients.

scholarly journals Metformin improves glycemic variability in adults with type 1 diabetes mellitus: an open-label randomized control trial

2021 ◽  
Author(s):  
Xiuzhen Zhang ◽  
Dan Xu ◽  
Ping Xu ◽  
Shufen Yang ◽  
Qingmei Zhang ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Glycemic Variability ◽  
Mean Amplitude ◽  
Insulin Requirement ◽  
Cvd Risk ◽  
Open Label ◽  
Metformin Therapy ◽  
Increased Risk

Introduction: Metformin has been demonstrated to enhance cardioprotective benefits in type 1 diabetes (T1DM). Although glycemic variability (GV) is associated with increased risk of CVD in diabetes, there is a scarcity of research evaluating the effect of metformin on GV in T1DM. Objectives: In the present study, the effects of adjuvant metformin therapy on GV and metabolic control in T1DM were explored. Patients and methods: A total of 65 adults with T1DM were enrolled and subjected to physical examination, fasting laboratory tests and continuous glucose monitoring, and subsequently randomized 1:1 to 3 months of 1000- 2000 mg metformin daily add-on insulin (MET group, n=34) or insulin (Non-MET group, n=31). After, baseline measurements were repeated. Results: The mean amplitude of glycemic excursions was substantially reduced in MET group, compared with Non-MET group [-1.58 (-3.35,0.31) mmol/L versus 1.36 (-1.12,2.24) mmol/L, P=0.004]. In parallel, the largest amplitude of glycemic excursions [-2.83 (-5.47,-0.06) mmol/L versus 0.45 (-1.29,4.48) mmol/L, P=0.004], the standard deviation of blood glucose [-0.85 (-1.51,0.01) mmol/L versus -0.14 (-0.68,1.21) mmol/L, P=0.015], and the coefficient of variation [-6.66 (-15.00,1.50) % versus -1.60 (-6.28,11.71) %, P=0.012] all demonstrated improvement in the MET group, compared with the Non-MET group. Significant reduction in insulin dose, body mass index and body weight were observed in patients in MET, not those in Non-MET group. Conclusion: Additional metformin therapy improved GV in adults with T1DM, as well as improving body composition and reducing insulin requirement. Hence, metformin as adjunctive therapy has potential prospects in reducing the CVD risk in patients with T1DM in the long term.

scholarly journals Healthy Pregnancy and Birth during Unusually Long-Lasting Remission of Type-1 Diabetes: Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 1-5
Author(s):  
Fövényi J ◽  
Pánczél P ◽  
Thaisz E
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Glargine ◽  
Basal Insulin ◽  
Insulin Dose ◽  
Challenge Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Daily Insulin

The 26-year-old woman was diagnosed with type 1 diabetes in 2014. The diagnosis was confirmed while there was a slight increase in blood glucose and HbA1c levels using oral glucose tolerance test, determination of insulin levels and GADA testing. This was followed by a 2-year period with complete remissions and partial remissions of 2-8 U daily basal insulin glargine. Thereafter, the patient became pregnant. The minimal basal insulin used to date has been switched to human rapid-acting and NPH insulins five times daily, which had to be increased to 11 times the initial dose in the third trimester of pregnancy. After a successful spontaneous birth of a healthy baby girl, our patient wished to return to one-tenth of the maximum insulin dose that was used during pregnancy, to once daily insulin glargine. After three months, her blood glucose levels began to rise, with oral glucose challenge test showing a marked increase in blood glucose and a drastic reduction in C-peptide levels. This was when we switched to multiple daily insulin administration using glargine basal- and glulisine analogue insulins. Later, glargine was switched to insulin degludec, and with a 30-33 U total daily insulin dose and CGM for the past two years, the patient was in a satisfactory metabolic state.

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