Continuous Glucose Monitoring-Recorded Hypoglycemia with Insulin Degludec or Insulin Glargine U100 in People with Type 1 Diabetes Prone to Nocturnal Severe Hypoglycemia.

Background and Aims: Nocturnal hypoglycemia is mainly a consequence of inappropriate basal insulin therapy in type 1 diabetes (T1D) and may compromise optimal glycemic control. Insulin degludec is associated with a lower risk of nocturnal hypoglycemia in T1D. As nocturnal hypoglycemia is often asymptomatic, we applied continuous glucose monitoring (CGM) to detect a more precise occurrence of nocturnal hypoglycemia in the HypoDeg trial, comparing insulin degludec with insulin glargine U100 in people with T1D and previous nocturnal severe hypoglycemia. Materials and Methods: In the HypoDeg trial, 149 people with T1D were included in an open-label randomized cross-over trial. Sixty-seven participants accepted optional participation in the predefined substudy of 4 × 6 days of blinded CGM requiring completion of at least one CGM period in each treatment arm. CGM data were reviewed for hypoglycemic events. Results: Treatment with insulin degludec resulted in a relative rate reduction (RRR) of 36% (95% confidence interval [CI]: 10%-54%; P < 0.05) in nocturnal CGM-recorded hypoglycemia (≤3.9 mmol/L), corresponding to an absolute rate reduction (ARR) of 0.85 events per person-week. In nocturnal CGM-recorded hypoglycemia (≤3.0 mmol/L), we found an RRR of 53% (95% CI: 36%-65%; P < 0.001), corresponding to an ARR of 0.75 events per person-week. At the lower detection limit of the CGM (≤2.2 mmol/L), treatment with insulin degludec resulted in a significant RRR of 58% (95% CI: 23%-77%; P = 0.005). The reductions were primarily due to significant RRRs in asymptomatic hypoglycemia. Conclusion: In people with T1D, prone to nocturnal severe hypoglycemia, insulin degludec compared with insulin glargine U100 significantly reduces nocturnal CGM-recorded hypoglycemia. www.clinicaltrials.gov (#NCT02192450).

Two-year treatment programme showed that younger age and initial weight loss predicted better results in overweight and obese children aged 2-16 years.

AIM: We investigated an outpatient programme that followed the Danish Paediatric Society's recommended multidisciplinary approach to treating overweight and obesity. METHODS: Our cohort comprised 179 participants (55.3% girls) treated from April 2011 until March 2016 at the Hospital of Southwest Jutland, Esbjerg, Denmark. The participant's age ranged from 2.3 to 16.6 years. The body mass index-standard deviation score was registered at inclusion and after three, 12 and 24 months. RESULTS: The girls were more obese than the boys at inclusion, and the mean reduction in the body mass index-standard deviation score was 0.3 units during the study. Half of the participants achieved a reduction in body mass index-standard deviation score of at least 0.25 units, and the frequency of obesity and severe obesity decreased from 69.3% to 47.5%. Predictors of weight loss were younger age and weight loss during the first 3 months. More than half (53.1%) completed the programme, and they were more likely to be younger and male. CONCLUSION: The two-year programme reduced the body mass index-standard deviation score and the frequency of obesity. Younger age and early weight loss predicted success and younger age, and male sex predicted completion rates.