المؤلفون: Philips, Jean-Christophe, Radermecker, Régis, Lebrethon, Marie-Christine, S, Scheen

المصدر: Revue Médicale de Liège, 77 (9), 538 - 543 (2022-09)

مصطلحات موضوعية: Coma, Emergency therapy, Glucagon, Hypoglycaemia, Type 1 diabetes, Child, Blood Glucose, Hypoglycemic Agents, Insulin, Adolescent, Adult, Coma/chemically induced, Glucagon/adverse effects, Glucagon/therapeutic use, Humans, Hypoglycemic Agents/adverse effects, Diabetes Mellitus, Type 1/complications, Diabetes Mellitus, Type 1/drug therapy, Hypoglycemia/chemically induced, Diabetes Mellitus, Type 1, Hypoglycemia, Medicine (all), Human health sciences, Endocrinology, metabolism & nutrition, Sciences de la santé humaine, Endocrinologie, métabolisme & nutrition

الوصف: editorial reviewed
Patients with insulin-treated type 1 diabetes (T1D) are exposed to hypoglycaemia, which may be serious. Serious cognitive impairment (including coma and seizure) that requires the help of a third party is a medical emergency. Besides the intravenous injection of glucose by a health care provider, its treatment consists of the subcutaneous or intramuscular injection of glucagon which may be performed by a family member. However, such an injection is not easy and puts off some people, which retards the initiation of a potentially life-saving therapy. The intranasal administration of 3 mg glucagon has been shown as efficacious as the subcutaneous or intramuscular injection of 1 mg glucagon in controlled studies carried out in both adult and youth patients with T1D. Stimulation and real-life studies among caregivers, patients and acquaintances showed a preference for nasal glucagon because of its easy and quick use. The launch of nasal glucagon (Baqsimi®) offers new perspectives for the ambulatory emergency management of severe hypoglycaemia and hypoglycaemic coma with a special obvious advantage in children.
La personne avec un diabète de type 1 (DT1) traité par insuline est exposée à un risque d’hypoglycémie, parfois grave. L'hypoglycémie sévère qui désigne tout trouble cognitif grave (y compris coma, convulsion) nécessitant l'intervention d'un tiers est une urgence médicale. Outre l’injection de glucose par voie intraveineuse, réservée à un personnel de santé, le traitement consiste en l’injection de glucagon par voie sous-cutanée ou intramusculaire qui peut être réalisée par un membre de l’entourage. Cependant, cette injection n’est pas aisée et rebute certaines personnes, ce qui retarde la mise en route d’un traitement potentiellement salvateur. L’administration nasale de glucagon 3 mg s’est avérée aussi performante que l’injection sous-cutanée ou intramusculaire de 1 mg dans des études contrôlées réalisées chez des patients DT1 adultes ou enfants/adolescents. Des études de simulation et de vraie vie réalisées auprès de soignants, de patients et de connaissances ont montré une préférence pour la forme nasale en raison de sa facilité et rapidité d’utilisation. La commercialisation du glucagon nasal (Baqsimi®) offre de nouvelles perspectives pour le traitement d’urgence ambulatoire de l'hypoglycémie sévère et du coma, avec un avantage particulièrement évident chez les enfants.

العلاقة: urn:issn:0370-629X; urn:issn:2566-1566

الوصول الحر: https://orbi.uliege.be/handle/2268/301110Test

المؤلفون: COUNE, Caroline, Paquot, Nicolas

المصدر: Revue Médicale Suisse, 18 (792), 1556-1559 (2022-08-24)

مصطلحات موضوعية: C-Peptide, Insulin, C-Peptide/metabolism, C-Peptide/therapeutic use, Disease Progression, Humans, Insulin/therapeutic use, Insulin Secretion, Quality of Life, Diabetes Mellitus, Type 1/drug therapy, Diabetes Mellitus, Type 1, Medicine (all), General Medicine, Human health sciences, Endocrinology, metabolism & nutrition, Sciences de la santé humaine, Endocrinologie, métabolisme & nutrition

الوصف: Plasma C-peptide represents a direct measure of endogenous insulin secretion. The development of new assays for measuring C-peptide have made it possible to demonstrate that a low insulin secretion persists in 30 to 80% of subjects with type 1 diabetes (T1D), even among those with long-standing disease. Several studies have established that the persistence of B cell function of the islets of Langerhans is associated with a protection against the development of microvascular complications and resulted in a significant reduction in the prevalence of severe hypoglycaemia in people with T1D. Further studies are needed to clarify the underlying pathophysiological mechanisms and the therapeutic strategies that would maintain B-cell function and thus improve the quality of life of patients with T1D.
Le peptide-C plasmatique constitue une mesure directe de la sécrétion endogène d’insuline. Le développement de nouveaux dosages du peptide-C a permis de démontrer qu’il persiste chez 30 à 80 % des sujets diabétiques de type 1 (DT1) une faible sécrétion d’insuline, même sur le long terme. Plusieurs études ont établi que la persistance de la fonction B des îlots de Langerhans était associée à une protection contre le développement des complications microvasculaires et engendrait une réduction significative de la prévalence des hypoglycémies sévères chez les personnes DT1. Mais des études complémentaires sont encore nécessaires afin de préciser les mécanismes physiopathologiques sous-jacents et les stratégies thérapeutiques qui permettraient de maintenir la fonction de la cellule B et d’améliorer ainsi la qualité de vie des sujets avec un DT1.

العلاقة: urn:issn:1660-9379

الوصول الحر: https://orbi.uliege.be/handle/2268/297232Test

المؤلفون: Gitte Øskov Skajaa, Ulla Kampmann, Per Glud Ovesen, Jens Fuglsang

المصدر: Skajaa, G Ø, Kampmann, U, Ovesen, P G & Fuglsang, J 2023, ' Breastfeeding and insulin requirements in women with Type 1 diabetes mellitus in the first year postpartum ', Acta Diabetologica, vol. 60, no. 7, pp. 899-906 . https://doi.org/10.1007/s00592-023-02068-1Test

مصطلحات موضوعية: Glycated Hemoglobin, Hb1Ac, Insulin requirements, Endocrinology, Diabetes and Metabolism, Postpartum Period, Diabetes Mellitus, Type 1/drug therapy, General Medicine, Overweight, Endocrinology, Breast Feeding, Postpartum, Pregnancy, Insulin/therapeutic use, Internal Medicine, T1DM, Pregnancy Weight Retention, Humans, Female, Prospective Studies

الوصف: Aims: To explore whether breastfeeding affects postpartum insulin requirements, HbA1c levels, and pregnancy weight retention in women with Type 1 Diabetes Mellitus (T1DM). Methods: This prospective study included 66 women with T1DM. The women were divided into two groups based on whether they were breastfeeding (BF) at 6 months postpartum (BF yes, n = 32) or not (BF no, n = 34). Mean daily insulin requirement (MDIR), HbA1c levels, and pregnancy weight retention at 5 time-points from discharge to 12 months postpartum were compared. Results: MDIR increased by 35% from 35.7 IU at discharge to 48.1 IU at 12 months postpartum (p < 0.001). MDIR in BF yes and BF no were comparable, however in BF yes, MDIR were continuously lower compared to BF no. Postpartum HbA1c increased rapidly from 6.8% at 1 month to 7.4% at 3 months postpartum and settled at 7.5% at 12 months postpartum. The increase in HbA1c during the first 3 months postpartum was most pronounced in BF no (p < 0.001). Although neither were statistically significant, from 3 months postpartum HbA1c levels were highest in the BF no and BF no had a higher pregnancy weight retention compared to BF yes (p = 0.31). Conclusion: In women with T1DM, breastfeeding did not significantly affect postpartum insulin requirements, HbA1c levels or pregnancy weight retention in the first year after delivery.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::19710dbf135f8f41a328c46fb23b46c1Test
https://pure.au.dk/portal/da/publications/breastfeeding-and-insulin-requirements-in-women-withTest-type-1-diabetes-mellitus-in-the-first-year-postpartum(c63c024b-3705-45be-8ba8-7e4f2646f1f3).html

المؤلفون: Jean Van Rampelbergh, Peter Achenbach, Richard David Leslie, Mohammad Alhadj Ali, Colin Dayan, Bart Keymeulen, Katharine R. Owen, Martin Kindermans, Frédéric Parmentier, Vincent Carlier, Roxana R. Ahangarani, Evelien Gebruers, Nicolas Bovy, Luc Vanderelst, Marcelle Van Mechelen, Pierre Vandepapelière, Christian Boitard

المساهمون: Pathology/molecular and cellular medicine, Diabetes Pathology & Therapy, Diabetes Clinic

مصطلحات موضوعية: Adult, Beta-cells, Endocrinology, Diabetes and Metabolism, T cells, Diabetes Mellitus, Type 1/drug therapy, Autoimmunity, General Medicine, CD8-Positive T-Lymphocytes, Clinical study, Type 1 diabetes, Disease Progression, Humans, immunotherapy, Safety, C-peptide

الوصف: Background Type 1 diabetes (T1D) is a CD4+ T cell-driven autoimmune disease characterized by the destruction of insulin-producing pancreatic β-cells by CD8+ T cells. Achieving glycemic targets in T1D remains challenging in clinical practice; new treatments aim to halt autoimmunity and prolong β-cell survival. IMCY-0098 is a peptide derived from human proinsulin that contains a thiol-disulfide oxidoreductase motif at the N-terminus and was developed to halt disease progression by promoting the specific elimination of pathogenic T cells. Methods This first-in-human, 24-week, double-blind phase 1b study evaluated the safety of three dosages of IMCY-0098 in adults diagnosed with T1D Results Treatment with IMCY-0098 was well tolerated with no systemic reactions; a total of 315 adverse events (AEs) were reported in 40 patients (97.6%) and were related to study treatment in 29 patients (68.3%). AEs were generally mild; no AE led to discontinuation of the study or death. No significant decline in C-peptide was noted from baseline to Week 24 for dose A, B, C, or placebo (mean change − 0.108, − 0.041, − 0.040, and − 0.012, respectively), suggesting no disease progression. Conclusions Promising safety profile and preliminary clinical response data support the design of a phase 2 study of IMCY-0098 in patients with recent-onset T1D. Trial registration IMCY-T1D-001: ClinicalTrials.gov NCT03272269; EudraCT: 2016–003514-27; and IMCY-T1D-002: ClinicalTrials.gov NCT04190693; EudraCT: 2018–003728-35.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a4b8a6e613bd0f20b00a20a87d940ab8Test
https://biblio.vub.ac.be/vubir/firstinhuman-doubleblind-randomized-phase-1b-study-of-peptide-immunotherapy-imcy0098-in-newonsetTest-type-1-diabetes(127c9c20-514f-4223-bb84-4343e49a3e7a).html

المؤلفون: Klavs Würgler Hansen, Bo Martin Bibby

المصدر: Hansen, K W & Bibby, B M 2022, ' Variation of glucose time in range in type 1 diabetes ', Endocrinology, Diabetes & Metabolism, vol. 5, no. 6, e379 . https://doi.org/10.1002/edm2.379Test

مصطلحات موضوعية: Blood Glucose, Continuous gluclose monitoring, Endocrinology, Diabetes and Metabolism, Blood Glucose Self-Monitoring, Glucose/therapeutic use, Diabetes Mellitus, Type 1/drug therapy, Insulin, Regular, Human/therapeutic use, Diabetes Mellitus, Type 1, Glucose, Insulin Infusion Systems, Type 1 diabetes, Insulin, Regular, Human, Insulin/therapeutic use, Time in range, Insulin, Humans

الوصف: INTRODUCTION: The aim of the study was to assess the variation of glucose time in range (TIR) for persons with type 1 diabetes who perform intermittently scanned continuous glucose monitoring (isCGM).METHODS: Glucose data for 8 weeks were analysed for 166 persons. TIR was calculated over four consecutive 2 weeks periods. Sixty-one of the persons had two downloads with an interval of >3 months.RESULTS: A total of 140 individuals (84%) used multiple daily injection, and 26 (16%) used continuous insulin infusion. The within-individual standard deviation (SD) for TIR was 6.3% corresponding to 95% limits of agreement for the difference between two TIR values of ±17.6%. Mean TIR calculated from the first and last 2 weeks was 52.2 ± 17.1% and 53.7 ± 16.4%, respectively (difference 1.5%, SD of the difference 10.4%, p = .07). For persons with two downloads separated by months, the SD of the difference in TIR was 12.6%.CONCLUSIONS: The 95% limit of agreement for TIR is vast for persons using isCGM. It is difficult to draw firm conclusions regarding systematic differences when individual TIR from 2 weeks are compared. This may not be valid for users of insulin pumps with closed-loop insulin delivery.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::96fc380a733eda9dc9e6032fe4564572Test
https://pure.au.dk/portal/da/publications/variation-of-glucose-time-in-range-inTest-type-1-diabetes(3af865cb-79e7-4f80-ad88-b1365c22e587).html

المؤلفون: Ulrike Schierloh, Gloria A. Aguayo, Anna Schritz, Muriel Fichelle, Cindy De Melo Dias, Michel T. Vaillant, Ohad Cohen, Inge Gies, Carine de Beaufort

المساهمون: Clinical sciences, Faculty of Medicine and Pharmacy, Growth and Development, Pediatrics

مصطلحات موضوعية: Blood Glucose, Cross-Over Studies, Blood Glucose Self-Monitoring, Endocrinology, Diabetes and Metabolism, Diabetes Mellitus, Type 1/drug therapy, Infant, Hypoglycemic Agents/therapeutic use, Hypoglycemia, Diabetes Mellitus, Type 1, Insulin/therapeutic use, Hypoglycemic Agents, Insulin, Humans, Female, Pediatrics, Perinatology, and Child Health, glucose, Child

الوصف: ObjectiveTo compare glycemic control and treatment preference in children with type 1 diabetes (T1D) using sensor augmented pump (SAP) with predictive low glucose suspend (SmartGuard®) or pump with independent intermittent scanning continuous glucose monitoring (iscCGM, Freestyle libre ®).MethodsIn this open label, cross-over study, children 6 to 14 years of age, treated with insulin pump for at least 6 months, were randomized to insulin pump and iscCGM (A) or SAP with SmartGuard® (B) for 5 weeks followed by 5 additional weeks. The difference in percentages of time in glucose target (TIT), (3.9 – 8.0 mmol/l), 8 and 10 mmol/l, were analyzed using linear mixed models during the final week of each arm and were measured by blinded CGM (IPro2®).Results31 children (15 girls) finished the study. With sensor compliance > 60%, no difference in TIT was found, TIT: A 37.86%; 95% CI [33.21; 42.51]; B 37.20%; 95% CI [32.59; 41.82]; < 3 mmol/l A 2.27% 95% CI [0.71; 3.84] B 1.42% 95% CI [-0.13; 2.97]; > 8 mmol/l A 0.60% 95% CI [0.56, 0.67]; B 0.63% [0.56; 0.70]. One year after the study all participants were on CGM compared to 80.7% prior to the study, with a shift of 13/25 participants from iscCGM to SAP.ConclusionsIn this study, no significant difference in glycemic control was found whether treated with SAP (SmartGuard®) or pump with iscCGM. The decision of all families to continue with CGM after the study suggests a positive impact, with preference for SmartGuard®.Clinical Trial Registration[clinicaltrials.gov], identifier NCT03103867.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dd3f77643a9445acf5ffd5651ac2077dTest
https://doi.org/10.3389/fendo.2022.870916Test

المؤلفون: Anders Nikolai Ørsted Schultz, Robin Christensen, Georg Bollig, Kristian Kidholm, F Brandt

المصدر: Schultz, A N Ø, Christensen, R, Bollig, G, Kidholm, K & Brandt, F 2022, ' Effectiveness of video consultations in type 1 diabetes patients treated with insulin pumps in the outpatient clinic : protocol for a randomised controlled trial ', BMJ Open, vol. 12, no. 4, e058728 . https://doi.org/10.1136/bmjopen-2021-058728Test

مصطلحات موضوعية: DIABETES & ENDOCRINOLOGY, Remote Consultation, education, Diabetes Mellitus, Type 1/drug therapy, General Medicine, Ambulatory Care Facilities, Telemedicine, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Insulin/therapeutic use, Humans, Insulin, Protocols & guidelines, Randomized Controlled Trials as Topic

الوصف: IntroductionThe purpose of the study is to assess the effectiveness of video consultations in patients with type 1 diabetes mellitus (DM) treated with insulin pumps in the outpatient clinic.Methods and analysisA 52 weeks’ duration, open-label, randomised controlled trial will be conducted, enrolling 100 patients with type 1 DM currently treated with insulin pump.Patients will be recruited from the diabetes outpatient clinic at Hospital of Southern Jutland, Department of internal medicine, Sønderborg. Participants will be randomised to either video consultations (experimental intervention) or standard care (control comparator). Participants in the video consultation group will follow their standard care treatment but will have all of their scheduled and non-scheduled appointments by video consultation. The control group will follow their standard care treatment as usual, having all their appointments at the outpatient centre. Primary outcome will be change from baseline of time in range (3.9–10.0 mmol/L).Ethics and disseminationThe study has been approved by the Regional Committe on Health Research Ethics for Southern Denmark, S-20200039G Acadre 20/12922. We will present the results of the trial at international conferences as well as publish the results of the trial in (a) peer-reviewed scientific journal(s).Trial registration numberNCT04612933.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bccccc4a78a6c47bc10ad7f4c31034aeTest
https://pubmed.ncbi.nlm.nih.gov/35477877Test

المؤلفون: Lee, Tara TM, Collett, Corinne, Man, Mei-See, Hammond, Matt, Shepstone, Lee, Hartnell, Sara, Gurnell, Eleanor, Byrne, Caroline, Scott, Eleanor M, Lindsay, Robert S, Morris, Damian, Brackenridge, Anna, Dover, Anna R, Reynolds, Rebecca M, Hunt, Katharine F, McCance, David R, Barnard-Kelly, Katharine, Rankin, David, Lawton, Julia, Bocchino, Laura E, Sibayan, Judy, Kollman, Craig, Wilinska, Malgorzata E, Hovorka, Roman, Murphy, Helen R, AiDAPT Collaborative Group

المساهمون: Murphy, Helen R [0000-0002-5489-0614], Apollo - University of Cambridge Repository, Ayman, G, Group, AiDAPT Collaborative

المصدر: Lee, T, Collett, C, Man, M-S, Hammond, M, Shepstone, L, Hartnell, S, Gurnell, E, Byrne, C, Scott, E M, Lindsay, R, Morris, D, Brackenridge, A, Dover, A, Reynolds, R, Hunt, K, McCrance, D, Barnard-Kelly, K, Rankin, D, Lawton, J, Bocchino, L, Sibayan, J, Kollman, C, Wilinska, M E, Hovorka, R & Murphy, H R 2022, ' AiDAPT: Automated insulin Delivery Amongst Pregnant women with Type 1 diabetes : A multicentre randomized controlled trial – study protocol ', BMC pregnancy and childbirth, vol. 22, no. 1, 282 . https://doi.org/10.1186/s12884-022-04543-zTest

مصطلحات موضوعية: Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1/drug therapy, Infant, Newborn, Obstetrics and Gynecology, Hypoglycemic Agents/therapeutic use, Blood Glucose/analysis, Study Protocol, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Pregnancy, Insulin/therapeutic use, Humans, Hypoglycemic Agents, Insulin, Multicenter Studies as Topic, Female, Pregnant Women, Randomized Controlled Trials as Topic

الوصف: Background Pregnant women with type 1 diabetes strive for tight glucose targets (3.5-7.8 mmol/L) to minimise the risks of obstetric and neonatal complications. Despite using diabetes technologies including continuous glucose monitoring (CGM), insulin pumps and contemporary insulin analogues, most women struggle to achieve and maintain the recommended pregnancy glucose targets. This study aims to evaluate whether the use of automated closed-loop insulin delivery improves antenatal glucose levels in pregnant women with type 1 diabetes. Methods/design A multicentre, open label, randomized, controlled trial of pregnant women with type 1 diabetes and a HbA1c of ≥48 mmol/mol (6.5%) at pregnancy confirmation and ≤ 86 mmol/mol (10%) at randomization. Participants who provide written informed consent before 13 weeks 6 days gestation will be entered into a run-in phase to collect 96 h (24 h overnight) of CGM glucose values. Eligible participants will be randomized on a 1:1 basis to CGM (Dexcom G6) with usual insulin delivery (control) or closed-loop (intervention). The closed-loop system includes a model predictive control algorithm (CamAPS FX application), hosted on an android smartphone that communicates wirelessly with the insulin pump (Dana Diabecare RS) and CGM transmitter. Research visits and device training will be provided virtually or face-to-face in conjunction with 4-weekly antenatal clinic visits where possible. Randomization will stratify for clinic site. One hundred twenty-four participants will be recruited. This takes into account 10% attrition and 10% who experience miscarriage or pregnancy loss. Analyses will be performed according to intention to treat. The primary analysis will evaluate the change in the time spent in the target glucose range (3.5-7.8 mmol/l) between the intervention and control group from 16 weeks gestation until delivery. Secondary outcomes include overnight time in target, time above target (> 7.8 mmol/l), standard CGM metrics, HbA1c and psychosocial functioning and health economic measures. Safety outcomes include the number and severity of ketoacidosis, severe hypoglycaemia and adverse device events. Discussion This will be the largest randomized controlled trial to evaluate the impact of closed-loop insulin delivery during type 1 diabetes pregnancy. Trial registration ISRCTN 56898625 Registration Date: 10 April, 2018.

وصف الملف: application/pdf; text/xml; application/vnd.openxmlformats-officedocument.wordprocessingml.document

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::be95ede108f8062b812aee1441771a60Test
https://www.repository.cam.ac.uk/handle/1810/336911Test

المؤلفون: Michael C. Riddell, Louisa van den Boom, Simon Heller, Peter G. Jacobs, Richard M. Bergenstal, Pieter Gillard, Carine de Beaufort, Martin Tauschmann, Max L. Eckstein, Tadej Battelino, Othmar Moser, Chantal Mathieu, Dessi P. Zaharieva, Richard M. Bracken, Harald Sourij, Peter Adolfsson, Carmel E. Smart, Nick Oliver, Christoph Stettler, Hood Thabit, Rémi Rabasa-Lhoret, Tim Heise, Julia K. Mader, Eda Cengiz, Lalantha Leelarathna, Aaron J. Kowalski, Kirsten Nørgaard, Bruce A. Buckingham, Asma Deeb, Emma G. Wilmot

المساهمون: Pathology/molecular and cellular medicine, Diabetes Pathology & Therapy, Diabetes Clinic

المصدر: Pediatric Diabetes
Moser, Othmar; Riddell, Michael C; Eckstein, Max L; Adolfsson, Peter; Rabasa-Lhoret, Rémi; van den Boom, Louisa; Gillard, Pieter; Nørgaard, Kirsten; Oliver, Nick S; Zaharieva, Dessi P; Battelino, Tadej; de Beaufort, Carine; Bergenstal, Richard M; Buckingham, Bruce; Cengiz, Eda; Deeb, Asma; Heise, Tim; Heller, Simon; Kowalski, Aaron J; Leelarathna, Lalantha; ... (2020). Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Pediatric diabetes, 21(8), pp. 1375-1393. Wiley 10.1111/pedi.13105 <http://dx.doi.org/10.1111/pedi.13105Test>
Diabetolegia

مصطلحات موضوعية: 0301 basic medicine, Blood Glucose, Endocrinology, Diabetes and Metabolism, Position statement, Adolescents, 0302 clinical medicine, Exercise/physiology, Insulin, 610 Medicine & health, Child, Children, Continuous glucose monitoring, Quality Of Life, Diabetes Mellitus, Type 1/physiopathology, Glucose management, Type 1 diabetes, Adult, medicine.medical_specialty, Adolescent, Diabetes Mellitus, Type 1/drug therapy, 030209 endocrinology & metabolism, Physical exercise, Glycemic Control, 03 medical and health sciences, Diabetes mellitus, Internal Medicine, medicine, Adults, Humans, Hypoglycemic Agents, Pediatrics, Perinatology, and Child Health, Exercise, American diabetes association, Health professionals, Blood Glucose/metabolism, business.industry, CGM, Physical activity, Blood Glucose Self-Monitoring, medicine.disease, Hypoglycemic Agents/administration & dosage, 030104 developmental biology, Diabetes Mellitus, Type 1, Physical therapy, Ispad Guidelines, Glycemic Control/methods, business, Insulin/administration & dosage

الوصف: Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. ispartof: PEDIATRIC DIABETES vol:21 issue:8 pages:1375-1393 ispartof: location:Denmark status: published

وصف الملف: application/pdf; Print-Electronic

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::71e8f226f623aa0eb01f9012920db823Test
http://europepmc.org/articles/PMC7702152Test

المؤلفون: Johan Jendle, Paresh Dandona, John Xu, Nayyar Iqbal, Enrico Repetto, Markus F. Scheerer, Steven V. Edelman, Per-Henrik Groop, Fredrik Thoren, Moshe Phillip, Pieter Gillard, Chantal Mathieu

المساهمون: Pathology/molecular and cellular medicine, Diabetes Pathology & Therapy, Diabetes Clinic

المصدر: The Lancet Diabetes & Endocrinology. 8:845-854

مصطلحات موضوعية: Blood Glucose, Male, Endocrinology, Diabetes and Metabolism, Biomarkers/analysis, Glycated Hemoglobin A/analysis, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Glucosides, Insulin, 030212 general & internal medicine, Dapagliflozin, Prospective cohort study, education.field_of_study, Middle Aged, Prognosis, Diabetic Ketoacidosis/prevention & control, Insulin/therapeutic use, Creatinine, Drug Therapy, Combination, Female, medicine.symptom, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Adolescent, Diabetic ketoacidosis, Albuminuria/prevention & control, Population, Diabetes Mellitus, Type 1/drug therapy, Hypoglycemic Agents/therapeutic use, 030209 endocrinology & metabolism, Placebo, Diabetic Ketoacidosis, Young Adult, 03 medical and health sciences, Double-Blind Method, Benzhydryl Compounds/therapeutic use, Internal medicine, Internal Medicine, medicine, Albuminuria, Humans, Hypoglycemic Agents, Benzhydryl Compounds, Adverse effect, education, Sodium-Glucose Transporter 2 Inhibitors, Aged, Glycated Hemoglobin, Type 1 diabetes, business.industry, Sodium-Glucose Transporter 2 Inhibitors/therapeutic use, Blood Glucose/analysis, Creatinine/blood, medicine.disease, Glucosides/therapeutic use, Diabetes Mellitus, Type 1, chemistry, business, Biomarkers, Follow-Up Studies

الوصف: Summary Background The DEPICT-1 and DEPICT-2 studies showed that dapagliflozin as an adjunct to insulin in individuals with inadequately controlled type 1 diabetes improved glycaemic control and bodyweight, without increase in risk of hypoglycaemia. We aimed to determine the effect of dapagliflozin on urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) using pooled data from the DEPICT studies. Methods In this post-hoc analysis, we used data pooled from both DEPICT studies (DEPICT-1 ran from Nov 11, 2014, to Aug 25, 2017; DEPICT-2 ran from July 8, 2015, to April 18, 2018), in which participants were aged 18–75 years, with inadequately controlled type 1 diabetes and with a baseline UACR of at least 30 mg/g. In the DEPICT studies, participants were randomly assigned (1:1:1) to receive dapagliflozin (5 mg or 10 mg) or placebo all plus insulin, for 24 weeks, with a 28-week long-term extension (ie, 52 weeks in total). In this post-hoc analysis, we assessed the percentage change from baseline in UACR and in eGFR, up to 52 weeks. UACR, eGFR, and safety were assessed in all eligible participants who had received at least one dose of study drug. HbA1c, bodyweight, and systolic blood pressure were assessed in all participants who received at least one dose of study drug during the first 24-week period, and who had a baseline and any post-baseline assessment for that parameter. The DEPICT trials were registered with ClinicalTrials.gov , NCT02268214 (DEPICT-1), NCT02460978 (DEPICT-2), and are now complete. Results 251 participants with albuminuria at baseline were included in this post-hoc analysis; of whom 80 (32%) had been randomly assigned to dapagliflozin 5 mg, 84 (33%) to dapagliflozin 10 mg, and 87 (35%) to placebo. Compared with placebo, treatment with both dapagliflozin doses improved UACR over 52 weeks. At week 52, mean difference in change from baseline versus placebo in UACR was −13·3% (95% CI −37·2 to 19·8) for dapagliflozin 5 mg and −31·1% (−49·9 to −5·2) for dapagliflozin 10 mg. No notable change from baseline was seen in eGFR, with a mean difference in change from baseline versus placebo of 3·27 mL/min per 1·73 m2 (95% CI −0·92 to 7·45) for dapagliflozin 5 mg and 2·12 mL/min per 1·73 m2 (–2·03 to 6·27) for dapagliflozin 10 mg. Similar proportions of participants in each treatment group had adverse events and serious adverse events, including hypoglycaemia and diabetic ketoacidosis; no new safety signals were identified in this population. Interpretation Treatment with dapagliflozin resulted in UACR reduction, which might provide renoprotective benefits in individuals with type 1 diabetes and albuminuria. Dedicated prospective studies are needed to confirm these findings as prespecified endpoints. Funding AstraZeneca.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::00f7846f46b1b29ed6f481ec3393eac5Test
https://doi.org/10.1016/s2213-8587Test(20)30280-1