المؤلفون: Faggionato, Edoardo, Schiavon, Michele, Ekhlaspour, Laya, Buckingham, Bruce, Dalla Man, Chiara

المصدر: IEEE Transactions on Biomedical Engineering. 71(3)

مصطلحات موضوعية: Humans, Adult, Middle Aged, Glucose, Diabetes Mellitus, Type 1, Insulin Resistance, Blood Glucose, Blood Glucose Self-Monitoring, Bayes Theorem, Insulin, Hypoglycemic Agents

الوصف: OBJECTIVE: Modeling the effect of meal composition on glucose excursion would help in designing decision support systems (DSS) for type 1 diabetes (T1D) management. In fact, macronutrients differently affect post-prandial gastric retention (GR), rate of appearance (R[Formula: see text]), and insulin sensitivity (S[Formula: see text]). Such variables can be estimated, in inpatient settings, from plasma glucose (G) and insulin (I) data using the Oral glucose Minimal Model (OMM) coupled with a physiological model of glucose transit through the gastrointestinal tract (reference OMM, R-OMM). Here, we present a model able to estimate those quantities in daily-life conditions, using minimally-invasive (MI) technologies, and validate it against the R-OMM. METHODS: Forty-seven individuals with T1D (weight =78±13 kg, age =42±10 yr) underwent three 23-hour visits, during which G and I were frequently sampled while wearing continuous glucose monitoring (CGM) and insulin pump (IP). Using a Bayesian Maximum A Posteriori estimator, R-OMM was identified from plasma G and I measurements, and MI-OMM was identified from CGM and IP data. RESULTS: The MI-OMM fitted the CGM data well and provided precise parameter estimates. GR and R[Formula: see text] model parameters were not significantly different using the MI-OMM and R-OMM (p 0.05) and the correlation between the two S[Formula: see text] was satisfactory ( ρ =0.77). CONCLUSION: The MI-OMM is usable to estimate GR, R[Formula: see text], and S[Formula: see text] from data collected in real-life conditions with minimally-invasive technologies. SIGNIFICANCE: Applying MI-OMM to datasets where meal compositions are available will allow modeling the effect of each macronutrient on GR, R[Formula: see text], and S[Formula: see text]. DSS could finally exploit this information to improve diabetes management.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4zm3c05sTest

المؤلفون: Cardona-Hernandez, Roque, Dôvc, Klemen, Biester, Torben, Macedoni, Maddalena, Tauschmann, Martin, Mameli, Chiara, Ekhlaspour, Laya

مصطلحات موضوعية: Automated insulin delivery, Children, Technology, Time in range, Type 1 diabetes, Youths, Young Adult, Humans, Adolescent, Child, Adult, Diabetes Mellitus, Type 1, Hypoglycemic Agents, Glycemic Control, Blood Glucose Self-Monitoring, Blood Glucose, Insulin, Insulin Infusion Systems

الوصف: Type 1 diabetes (T1D) is the most frequent form of diabetes in pediatric age, affecting more than 1.5 million people younger than age 20 years worldwide. Early and intensive control of diabetes provides continued protection against both microvascular and macrovascular complications, enhances growth, and ensures normal pubertal development. In the absence of definitive reversal therapy for this disease, achieving and maintaining the recommended glycemic targets is crucial. In the last 30 years, enormous progress has been made using technology to better treat T1D. In spite of this progress, the majority of children, adolescents and young adults do not reach the recommended targets for glycemic control and assume a considerable burden each day. The development of promising new therapeutic advances, such as more physiologic insulin analogues, pioneering diabetes technology including continuous glucose monitoring and closed loop systems as well as new adjuvant drugs, anticipate a new paradigm in T1D management over the next few years. This review presents insights into current management of T1D in youths.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/7s31w37tTest

المؤلفون: Castellanos, Luz, Russell, Steven, Damiano, Edward, Beck, Roy, Shah, Viral, Bailey, Ryan, Calhoun, Peter, Bird, Keisha, Mauras, Nelly

المصدر: Diabetes reviews (Alexandria, Va.). 46(6)

مصطلحات موضوعية: Adult, Child, Humans, Bionics, Blood Glucose, Diabetes Mellitus, Type 1, Glycemic Control, Insulin, Pancreas, White People, Minority Groups, Artificial Organs

الوصف: OBJECTIVE: We evaluated the performance of the iLet bionic pancreas (BP) in non-Hispanic White individuals (here referred to as Whites) and in Black, Hispanic, and other individuals (here collectively referred to as Minorities). RESEARCH DESIGN AND METHODS: A multicenter, randomized controlled trial evaluated glycemic management with the BP versus standard of care (SC) in 161 adult and 165 pediatric participants with type 1 diabetes over 13 weeks. RESULTS: In Whites (n = 240), the mean baseline-adjusted difference in 13-week HbA1c between the BP and SC groups was -0.45% (95% CI -0.61 to -0.29 [-4.9 mmol/mol; -6.6 to -3.1]; P < 0.001), while this difference among Minorities (n = 84) was -0.53% (-0.83 to -0.24 [-6.0 mmol/mol; -9.2 to -2.8]; P < 0.001). In Whites, the mean baseline-adjusted difference in time in range between the BP and SC groups was 10% (95% CI 7-12; P < 0.001) and in Minorities was 14% (10-18; P < 0.001). CONCLUSIONS: The BP improves glycemic control in both Whites and Minorities and offers promise in decreasing health care disparities.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/93b6j76dTest
https://escholarship.org/content/qt93b6j76d/qt93b6j76d.pdfTest

المؤلفون: Reaven, Peter D, Newell, Michelle, Rivas, Salvador, Zhou, Xinkai, Norman, Gregory J, Zhou, Jin J

المصدر: Diabetes Care. 46(4)

مصطلحات موضوعية: Autoimmune Disease, Diabetes, Clinical Research, Prevention, Metabolic and endocrine, Adult, Humans, Diabetes Mellitus, Type 2, Blood Glucose, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Retrospective Studies, Blood Glucose Self-Monitoring, Glycemic Control, Veterans Health, Hypoglycemic Agents, Hypoglycemia, Insulin, Hyperglycemia, Insulin, Regular, Human

الوصف: ObjectiveTo determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events.Research design and methodsA retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months.ResultsCGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (-0.26%; 95% CI -0.33, -0.19%) and T2D (-0.35%; 95% CI -0.40, -0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/07x0j9dzTest

المؤلفون: Pinsker, Jordan, Dassau, Eyal, Deshpande, Sunil, Raghinaru, Dan, Buckingham, Bruce, Kudva, Yogish, Laffel, Lori, Levy, Carol, Church, Mei, Desrochers, Hannah, Ekhlaspour, Laya, Kaur, Ravinder, Levister, Camilla, Shi, Dawei, Lum, John, Kollman, Craig, Doyle, Francis

المصدر: Diabetes Technology and Therapeutics. 24(9)

مصطلحات موضوعية: Adaptation, Artificial pancreas, Automated insulin delivery, Glycemic control, Type 1 diabetes, Adult, Blood Glucose, Cross-Over Studies, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Infant, Newborn, Insulin, Insulin Infusion Systems, Insulin, Regular, Human, Middle Aged, Outpatients, Young Adult

الوصف: Background: Automated insulin delivery (AID) systems have proven effective in increasing time-in-range during both clinical trials and real-world use. Further improvements in outcomes for single-hormone (insulin only) AID may be limited by suboptimal insulin delivery settings. Methods: Adults (≥18 years of age) with type 1 diabetes were randomized to either sensor-augmented pump (SAP) (inclusive of predictive low-glucose suspend) or adaptive zone model predictive control AID for 13 weeks, then crossed over to the other arm. Each week, the AID insulin delivery settings were sequentially and automatically updated by an adaptation system running on the study phone. Primary outcome was sensor glucose time-in-range 70-180 mg/dL, with noninferiority in percent time below 54 mg/dL as a hierarchical outcome. Results: Thirty-five participants completed the trial (mean age 39 ± 16 years, HbA1c at enrollment 6.9% ± 1.0%). Mean time-in-range 70-180 mg/dL was 66% with SAP versus 69% with AID (mean adjusted difference +2% [95% confidence interval: -1% to +6%], P = 0.22). Median time

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/76x9t6n0Test

المؤلفون: Kanbour, Sarah, Jones, Marissa, Abusamaan, Mohammed, Nass, Caitlin, Everett, Estelle, Wolf, Risa, Sidhaye, Aniket, Mathioudakis, Nestoras

المصدر: Diabetes reviews (Alexandria, Va.). 46(1)

مصطلحات موضوعية: Child, Adolescent, Humans, Adult, Diabetes Mellitus, Type 1, Retrospective Studies, Cohort Studies, Blood Glucose, Academic Medical Centers

الوصف: OBJECTIVE: Recent studies highlight racial disparities in insulin pump (PUMP) and continuous glucose monitor (CGM) use in children and adolescents with type 1 diabetes (T1D). This study explored racial disparities in diabetes technology among adult patients with T1D. RESEARCH DESIGN AND METHODS: This was a retrospective clinic-based cohort study of adult patients with T1D seen consecutively from April 2013 to January 2020. Race was categorized into non-Black (reference group) and Black. The primary outcomes were baseline and prevalent technology use, rates of diabetes technology discussions (CGMdiscn, PUMPdiscn), and prescribing (CGMrx, PUMPrx). Multivariable logistic regression analysis evaluated the association of technology discussions and prescribing with race, adjusting for social determinants of health and diabetes outcomes. RESULTS: Among 1,258 adults with T1D, baseline technology use was significantly lower for Black compared with non-Black patients (7.9% vs. 30.3% for CGM; 18.7% vs. 49.6% for PUMP), as was prevalent use (43.6% vs. 72.1% for CGM; 30.7% vs. 64.2% for PUMP). Black patients had adjusted odds ratios (aORs) of 0.51 (95% CI 0.29, 0.90) for CGMdiscn and 0.61 (95% CI 0.41, 0.93) for CGMrx. Black patients had aORs of 0.74 (95% CI 0.44, 1.25) for PUMPdiscn and 0.40 (95% CI, 0.22, 0.70) for PUMPrx. Neighborhood context, insurance, marital and employment status, and number of clinic visits were also associated with the outcomes. CONCLUSIONS: Significant racial disparities were observed in discussions, prescribing, and use of diabetes technology. Further research is needed to identify the causes behind these disparities and develop and evaluate strategies to reduce them.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5gv083gfTest

المؤلفون: Pettus, Jeremy, Boeder, Schafer C, Christiansen, Mark P, Denham, Douglas S, Bailey, Timothy S, Akturk, Halis K, Klaff, Leslie J, Rosenstock, Julio, Cheng, Mickie HM, Bode, Bruce W, Bautista, Edgar D, Xu, Ren, Yan, Hai, Thai, Dung, Garg, Satish K, Klein, Samuel

المصدر: Nature Medicine. 28(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Diabetes, Autoimmune Disease, Prevention, Clinical Trials and Supportive Activities, Clinical Research, 5.1 Pharmaceuticals, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Development of treatments and therapeutic interventions, Metabolic and endocrine, Adult, Antibodies, Monoclonal, Humanized, Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, Double-Blind Method, Glucagon, Glycated Hemoglobin, Humans, Insulin, Lipoproteins, LDL, Receptors, Glucagon, Transaminases, Treatment Outcome, Medical and Health Sciences, Immunology, Biomedical and clinical sciences, Health sciences

الوصف: Hyperglucagonemia contributes to hyperglycemia in patients with type 1 diabetes (T1D); however, novel therapeutics that block glucagon action could improve glycemic control. This phase 2 study evaluated the safety and efficacy of volagidemab, an antagonistic monoclonal glucagon receptor (GCGR) antibody, as an adjunct to insulin therapy in adults with T1D. The primary endpoint was change in daily insulin use at week 12. Secondary endpoints included changes in hemoglobin A1c (HbA1c) at week 13, in average daily blood glucose concentration and time within target range as assessed by continuous blood glucose monitoring (CGM) and seven-point glucose profile at week 12, incidence of hypoglycemic events, the proportion of subjects who achieve HbA1c reduction of ≥0.4%, volagidemab drug concentrations and incidence of anti-drug antibodies. Eligible participants (n = 79) were randomized to receive weekly subcutaneous injections of placebo, 35 mg volagidemab or 70 mg volagidemab. Volagidemab produced a reduction in total daily insulin use at week 12 (35 mg volagidemab: -7.59 units (U) (95% confidence interval (CI) -11.79, -3.39; P = 0.040 versus placebo); 70 mg volagidemab: -6.64 U (95% CI -10.99, -2.29; P = 0.084 versus placebo); placebo: -1.27 U (95% CI -5.4, 2.9)) without meeting the prespecified significance level (P

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4zh8n26kTest

المؤلفون: Russell, Steven, Beck, Roy, Damiano, Edward, El-Khatib, Firas, Ruedy, Katrina, Balliro, Courtney, Li, Zoey, Calhoun, Peter, Wadwa, R, Buckingham, Bruce, Zhou, Keren, Daniels, Mark, Raskin, Philip, White, Perrin, Lynch, Jane, Pettus, Jeremy, Hirsch, Irl, Goland, Robin, Buse, John, Kruger, Davida, Mauras, Nelly, Muir, Andrew, McGill, Janet, Cogen, Fran, Weissberg-Benchell, Jill, Sherwood, Jordan, Castellanos, Luz, Hillard, Mallory, Tuffaha, Marwa, Putman, Melissa, Sands, Mollie, Forlenza, Gregory, Slover, Robert, Messer, Laurel, Cobry, Erin, Shah, Viral, Polsky, Sarit, Lal, Rayhan, Ekhlaspour, Laya, Hughes, Michael, Basina, Marina, Hatipoglu, Betul, Olansky, Leann, Bhangoo, Amrit, Forghani, Nikta, Kashmiri, Himala, Sutton, Francoise, Choudhary, Abha, Penn, Jimmy, Jafri, Rabab, Rayas, Maria, Escaname, Elia, Kerr, Catherine, Favela-Prezas, Ruby, Trikudanathan, Subbulaxmi, Williams, Kristen, Leibel, Natasha, Kirkman, M, Bergamo, Kate, Klein, Klara, Dostou, Jean, Machineni, Sriram, Young, Laura, Diner, Jamie, Bhan, Arti, Jones, J, Benson, Matthew, Bird, Keisha, Englert, Kimberly, Permuy, Joe, Cossen, Kristina, Felner, Eric, Salam, Maamoun, Silverstein, Julie, Adamson, Samantha, Cedeno, Andrea, Meighan, Seema, Dauber, Andrew, Boeder, Schafer

المصدر: The New England Journal of Medicine. 387(13)

مصطلحات موضوعية: Adolescent, Adult, Aged, Bionics, Blood Glucose, Blood Glucose Self-Monitoring, Child, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Insulin Aspart, Insulin Infusion Systems, Insulin Lispro, Middle Aged, Young Adult

الوصف: BACKGROUND: Currently available semiautomated insulin-delivery systems require individualized insulin regimens for the initialization of therapy and meal doses based on carbohydrate counting for routine operation. In contrast, the bionic pancreas is initialized only on the basis of body weight, makes all dose decisions and delivers insulin autonomously, and uses meal announcements without carbohydrate counting. METHODS: In this 13-week, multicenter, randomized trial, we randomly assigned in a 2:1 ratio persons at least 6 years of age with type 1 diabetes either to receive bionic pancreas treatment with insulin aspart or insulin lispro or to receive standard care (defined as any insulin-delivery method with unblinded, real-time continuous glucose monitoring). The primary outcome was the glycated hemoglobin level at 13 weeks. The key secondary outcome was the percentage of time that the glucose level as assessed by continuous glucose monitoring was below 54 mg per deciliter; the prespecified noninferiority limit for this outcome was 1 percentage point. Safety was also assessed. RESULTS: A total of 219 participants 6 to 79 years of age were assigned to the bionic-pancreas group, and 107 to the standard-care group. The glycated hemoglobin level decreased from 7.9% to 7.3% in the bionic-pancreas group and did not change (was at 7.7% at both time points) in the standard-care group (mean adjusted difference at 13 weeks, -0.5 percentage points; 95% confidence interval [CI], -0.6 to -0.3; P

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1m5021wbTest

المؤلفون: Hendriks, A Emile J, Marcovecchio, M Loredana, Besser, Rachel EJ, Bonifacio, Ezio, Casteels, Kristina, Elding Larsson, Helena, Gemulla, Gita, Lundgren, Markus, Kordonouri, Olga, Mallone, Roberto, Pociot, Flemming, Szypowska, Agnieszka, Toppari, Jorma, Berge, Thekla von dem, Ziegler, Anette G, Mathieu, Chantal, Achenbach, Peter, INNODIA consortium, the Fr1da Study Group and the GPPAD Study Group

مصطلحات موضوعية: monitoring, presymptomatic type 1 diabetes, primary care, screening, specialist care, staging, Child, Adolescent, Adult, Humans, Diabetes Mellitus, Type 1, Autoantibodies, Blood Glucose Self-Monitoring, Blood Glucose, Diabetic Ketoacidosis

الوصف: BACKGROUND/AIM: Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis. METHODS: Expert consensus was obtained from members of the Fr1da, GPPAD, and INNODIA consortia, three European diabetes research groups. The guidance covers both specialist and primary care follow-up strategies. RESULTS: The guidance outlines recommended monitoring approaches based on age, disease stage and clinical setting. Individuals with presymptomatic type 1 diabetes are best followed up in specialist care. For stage 1, biannual assessments of random plasma glucose and HbA1c are suggested for children, while annual assessments are recommended for adolescents and adults. For stage 2, 3-monthly clinic visits with additional home monitoring are advised. The value of repeat OGTT in stage 1 and the use of continuous glucose monitoring in stage 2 are discussed. Primary care is encouraged to monitor individuals who decline specialist care, following the guidance presented. CONCLUSIONS: As type 1 diabetes screening programs become more prevalent, effective monitoring strategies are essential to mitigate the risk of complications such as DKA. This guidance serves as a valuable resource for clinicians, providing practical recommendations tailored to an individual's age and disease stage, both within specialist and primary care settings.

وصف الملف: application/vnd.ms-powerpoint; application/pdf

العلاقة: https://www.repository.cam.ac.uk/handle/1810/363959Test; https://doi.org/10.17863/CAM.105806Test

الإتاحة: https://doi.org/10.17863/CAM.105806Test
https://www.repository.cam.ac.uk/handle/1810/363959Test

المؤلفون: Marcovecchio, M Loredana, Hendriks, A Emile J, Delfin, Carl, Battelino, Tadej, Danne, Thomas, Evans, Mark L, Johannesen, Jesper, Kaur, Simranjeet, Knip, Mikael, Overbergh, Lut, Pociot, Flemming, Todd, John A, Van der Schueren, Bart, Wicker, Linda S, Peakman, Mark, Mathieu, Chantal, INNODIA consortium

مصطلحات موضوعية: Age, Beta cell function, C-peptide, Prevention, Subgroups, Treatment, Type 1 diabetes, Humans, Diabetes Mellitus, Type 1, Adolescent, Child, Male, Female, Adult, Young Adult, Preschool, Autoantibodies, Glycated Hemoglobin, Blood Glucose, Cohort Studies, Infant, Europe, Middle Aged, Insulin-Secreting Cells

الوصف: AIMS/HYPOTHESIS: Type 1 diabetes is an heterogenous condition. Characterising factors explaining differences in an individual's clinical course and treatment response will have important clinical and research implications. Our aim was to explore type 1 diabetes heterogeneity, as assessed by clinical characteristics, autoantibodies, beta cell function and glycaemic outcomes, during the first 12 months from diagnosis, and how it relates to age at diagnosis. METHODS: Data were collected from the large INNODIA cohort of individuals (aged 1.0-45.0 years) newly diagnosed with type 1 diabetes, followed 3 monthly, to assess clinical characteristics, C-peptide, HbA1c and diabetes-associated antibodies, and their changes, during the first 12 months from diagnosis, across three age groups: <10 years; 10-17 years; and ≥18 years. RESULTS: The study population included 649 individuals (57.3% male; age 12.1±8.3 years), 96.9% of whom were positive for one or more diabetes-related antibodies. Baseline (IQR) fasting C-peptide was 242.0 (139.0-382.0) pmol/l (AUC 749.3 [466.2-1106.1] pmol/l × min), with levels increasing with age (p<0.001). Over time, C-peptide remained lower in participants aged <10 years but it declined in all age groups. In parallel, glucose levels progressively increased. Lower baseline fasting C-peptide, BMI SD score and presence of diabetic ketoacidosis at diagnosis were associated with lower stimulated C-peptide over time. HbA1c decreased during the first 3 months (p<0.001), whereas insulin requirement increased from 3 months post diagnosis (p<0.001). CONCLUSIONS/INTERPRETATION: In this large cohort with newly diagnosed type 1 diabetes, we identified age-related differences in clinical and biochemical variables. Of note, C-peptide was lower in younger children but there were no main age differences in its rate of decline.

وصف الملف: application/pdf; text/xml

العلاقة: https://www.repository.cam.ac.uk/handle/1810/367743Test

الإتاحة: https://www.repository.cam.ac.uk/handle/1810/367743Test