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1.
Medicine (Baltimore) ; 99(2): e18679, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914062

RESUMO

This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Glicemia/análise , Hipoglicemia/epidemiologia , Adulto , Idoso , Comorbidade , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Reações Falso-Positivas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco
2.
Zhonghua Nei Ke Za Zhi ; 58(12): 889-893, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775451

RESUMO

Objective: To evaluate the effect of mobile application (APP) based interactive peer support on glycemic control in patients with type 1 diabetes mellitus (T1DM). Methods: The data of the present study were from the largest mobile APP platform for patients with T1DM in China, Tangtangquan. Patients with T1DM who has registered in the APP for at least 1 year and had completed data entry were recruited. According to the monthly interaction index during the first year of APP registration (including four indicators: praise, comment, posting and collection), the eligible patients were divided into the high-interaction group and the low-interaction group. The changes from baseline of self-blood glucose monitoring frequency (SMBG), glycosylated hemoglobin (HbA1c), incidence of hyperglycemia and incidence of hypoglycemia were compared between the two groups after one year of using the APP. Results: A total of 238 patients with T1DM with an age of (27±8) years were included. Among them, 77.3% (184/238) were female. The baseline SMBG [the low-interaction group (1.71±1.14) times/day vs. the high-interaction group (1.82±1.15) times/day] and HbA1c [the low-interaction group (6.72±0.99)% vs. the high-interaction group (6.76±1.04)%] were comparable between the two groups. After one year use of the APP, the frequency of SMBG in the high-interaction group was significantly higher than that in the low-interaction group [ΔSMBG (0.59+2.06) times/d vs. (0.08+1.69) times/d, t=4.280, P=0.04), and the reduction of HbA1c was more obvious in the high-interaction group [ΔHbA1c (-0.40+1.10)% vs. (-0.06+1.13)%, t=5.651, P=0.018] than in the lower-interaction group. The incidence of hyperglycemia in the high-interaction group was significantly lower than that in the low-interaction group [13.19(6.22,23.19)% vs. 17.69(10.56,30.49)%, Z=2.850, P=0.005]. There was no significant difference in the incidence of hypoglycemia between the two groups [4.62(2.14, 8.03)% vs. 4.83(2.06, 8.87)%, Z=1.276, P=0.204]. The correlation analysis showed that interaction index was significantly associated with the reduction of HbA1c and incidence of hyperglycemia. Conclusion: Participation in interactive peer education via mobile APP may be beneficent for glycemic control in patients with T1DM.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/sangue , Aplicativos Móveis , Grupo Associado , Adulto , Glicemia , China , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobina A Glicada , Humanos , Hiperglicemia/epidemiologia , Incidência , Pessoa de Meia-Idade , Cooperação do Paciente
3.
Orv Hetil ; 160(45): 1784-1790, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31680540

RESUMO

Introduction: It is known that lactate concentration is increased in diabetic ketoacidosis (DKA), however, the pathophysiology and kinetics of lactate changes are still unclear. Normally, L-lactate is the major form in the human body. According to previous data, also D- and L-lactate might be increased in hyperglycaemic disorders. Aim: We aimed to describe the kinetics and mechanisms of lactate concentration changes in ketoacidosis and newly diagnosed diabetes. Method: We performed a prospective study, including 5-18-year-old children with ketoacidosis (DKA, n = 13) and with newly diagnosed type 1 diabetes without ketoacidosis (T1DM, n = 6). We performed routine blood gas analysis 0-12-24-48 hours after admission, which also measured L-lactate levels. We also determined total venous serum lactate level by gas chromatography-mass spectrometry. Results: Initial plasma lactate concentration was increased in ketoacidosis as compared to the newly diagnosed diabetes group (p<0.05). After 12 h of rehydration, lactate levels were greatly reduced in ketoacidotic patients but after 24-48 h it was repeatedly increased (all p<0.01). In the 0-12 h phase, total serum lactate level was higher than L-lactate level, referring to D-lactate production. Conclusion: We described two L-lactate peaks in ketoacidosis. In the first 12 hours anaerobic glycolysis seems to have major role in hyperlactataemia. We assume that stimulated aerobic glycolysis leads to the second lactate peak. However, D-lactate is not routinely measured, it may contribute to the initial hyperlactataemia in both groups and is comparable to L-lactate production in ketoacidosis. Orv Hetil. 2019; 160(45): 1784-1790.


Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Ácido Láctico/sangue , Gasometria , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Cetoacidose Diabética/sangue , Cetoacidose Diabética/diagnóstico , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hiperglicemia/sangue , Masculino , Estudos Prospectivos
4.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 540-549, nov. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184376

RESUMO

Introduction: Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. Objective: To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2alfa) in children with T1DM. Materials and methods: A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. - Capillary HbA1c level. - 24-h urine sample to measure 8-iso-PGF2alfa. Results: There were no statistically significant differences in urinary 8-iso-PGF2alfa levels (142 ± 37 vs. 172 ± 61 pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2alfa and HbA1c levels (r = 0.53), MBG (r = 0.72), standard deviation (r = 0.49), and MAGE (r = 0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2alfa excretion were found in the 1st phase. Conclusions: A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health


Introducción: En niños con diabetes tipo 1 (DM1) hay pocos estudios que evalúen la relación entre estrés oxidativo y variabilidad glucémica, y la mayoría de ellos no encuentran resultados significativos. Objetivo: Evaluar la relación entre control metabólico, variabilidad glucémica y estrés oxidativo medido por la excreción urinaria de 8-iso-prostaglandina F2 alfa (8-iso-PGF2alfa) en niños con DM1. Material y método: Estudio transversal que incluyó 25 niños con DM1. Los participantes fueron evaluados durante 5 días en 2 situaciones diferentes: 1.a fase durante un campamento de verano y 2.a fase durante su actividad habitual en domicilio. En cada fase se recogieron:- Seis determinaciones de glucemia capilar diarias. Se calcularon glucemia media y parámetros de variabilidad glucémica: desviación estándar, coeficiente de variación y «mean amplitude of glycemic excursions» (MAGE). - HbA1c capilar. - Muestra de orina de 24h para la determinación de 8-iso-PGF2alfa. Resultados: No se encontraron diferencias estadísticamente significativas en excreción urinaria de 8-iso-PGF2alfa (142 ± 37 vs. 172 ± 61 pg/mg creatinina) y parámetros de control y variabilidad glucémicos entre las fases. En la 2.a fase se observaron correlaciones estadísticamente significativas entre 8-iso-PGF2alfa urinario con HbA1c (r = 0,53), glucemia media (r = 0,72), desviación estándar (r = 0,49) y MAGE (r = 0,42). En la 1.a fase del estudio no se han detectado correlaciones significativas. Conclusiones: Se ha encontrado una correlación significativa entre parámetros de variabilidad glucémica y HbA1c con la excreción urinaria de 8-iso-PGF2alfa en un grupo de niños con DM1 evaluados durante su vida diaria. Son necesarios más estudios para confirmar estos resultados y evaluar el impacto a largo plazo sobre la salud


Assuntos
Humanos , Criança , Diabetes Mellitus Tipo 1/complicações , Estresse Oxidativo , Índice Glicêmico , Metabolismo Basal , Dinoprosta/análogos & derivados , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Estudos Transversais , Diabetes Mellitus Tipo 1/urina , Dinoprosta/sangue
5.
N Engl J Med ; 381(18): 1707-1717, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31618560

RESUMO

BACKGROUND: Closed-loop systems that automate insulin delivery may improve glycemic outcomes in patients with type 1 diabetes. METHODS: In this 6-month randomized, multicenter trial, patients with type 1 diabetes were assigned in a 2:1 ratio to receive treatment with a closed-loop system (closed-loop group) or a sensor-augmented pump (control group). The primary outcome was the percentage of time that the blood glucose level was within the target range of 70 to 180 mg per deciliter (3.9 to 10.0 mmol per liter), as measured by continuous glucose monitoring. RESULTS: A total of 168 patients underwent randomization; 112 were assigned to the closed-loop group, and 56 were assigned to the control group. The age range of the patients was 14 to 71 years, and the glycated hemoglobin level ranged from 5.4 to 10.6%. All 168 patients completed the trial. The mean (±SD) percentage of time that the glucose level was within the target range increased in the closed-loop group from 61±17% at baseline to 71±12% during the 6 months and remained unchanged at 59±14% in the control group (mean adjusted difference, 11 percentage points; 95% confidence interval [CI], 9 to 14; P<0.001). The results with regard to the main secondary outcomes (percentage of time that the glucose level was >180 mg per deciliter, mean glucose level, glycated hemoglobin level, and percentage of time that the glucose level was <70 mg per deciliter or <54 mg per deciliter [3.0 mmol per liter]) all met the prespecified hierarchical criterion for significance, favoring the closed-loop system. The mean difference (closed loop minus control) in the percentage of time that the blood glucose level was lower than 70 mg per deciliter was -0.88 percentage points (95% CI, -1.19 to -0.57; P<0.001). The mean adjusted difference in glycated hemoglobin level after 6 months was -0.33 percentage points (95% CI, -0.53 to -0.13; P = 0.001). In the closed-loop group, the median percentage of time that the system was in closed-loop mode was 90% over 6 months. No serious hypoglycemic events occurred in either group; one episode of diabetic ketoacidosis occurred in the closed-loop group. CONCLUSIONS: In this 6-month trial involving patients with type 1 diabetes, the use of a closed-loop system was associated with a greater percentage of time spent in a target glycemic range than the use of a sensor-augmented insulin pump. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; iDCL ClinicalTrials.gov number, NCT03563313.).


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Pâncreas Artificial , Adolescente , Adulto , Idoso , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Desenho de Equipamento , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Sistemas de Infusão de Insulina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pâncreas Artificial/efeitos adversos , Adulto Jovem
6.
Ned Tijdschr Geneeskd ; 1632019 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-31556504

RESUMO

New technological developments have an important impact on the treatment of type 1 diabetes patients. These advancements concern the administration of insulin through an insulin pump, glucose level measurement with a sensor positioned on the skin, and the growing dynamic interactive options to link the glucose sensor and insulin pump. In this article a brief overview is provided of the existing methods, plus a summary of a study into the effect of a hybrid closed loop. Points of discussion include applicability, tolerability, long-term results and outcome measures that are most relevant to patients.


Assuntos
Automonitorização da Glicemia/instrumentação , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino
7.
Undersea Hyperb Med ; 46(4): 437-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509900

RESUMO

Introduction: To determine if hyperbaric oxygen (HBO2) therapy has an effect on diabetic blood glucose levels (BGL) and, if so, the extent of this effect. Also, to examine factors that exacerbate any observed effect. Methods: This was a retrospective review of prospectively collected quality data on diabetics undergoing HBO2. Pre- and post-treatment BGL were recorded. Pre-treatment BGL ⟨120 mg/dL received glucose supplementation. Hypoglycemia was defined as BGL ⟨70 mg/dL. BGL ⟨90 mg/dL was included as an elevated hypoglycemia threshold. Results: 77 patients representing 1,825 treatments were included for analysis. No patient had deleterious side effects or required emergency care. BGL decreased in 75.4% of treatments in this group, with a median decrease of 25 mg/dL (IQR=54 mg/dL; range of decreased 374 mg/dL to increased 240 mg/dL). A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001). 1.1% of treatments had post-HBO2 serum glucose ⟨90 mg/dL, and 0.2% of treatments had post-HBO2 serum glucose ⟨70 mg/dL. The majority (70%) of patients with post-HBO2 BGL ⟨90 mg/dL were maintained on insulin alone (χ2(2, N=20) =12.4, p=0.002). Well-controlled diabetics (i.e., those with all BGLs within 50 mg/dL over all pre-HBO2 treatments) had no post-HBO2 BGL ⟨70 mg/dL or ⟨90 mg/dL. Conclusion: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. Hyperbaric patients who exhibit consistent BGL values may represent a group who could be managed similarly to the non-diabetic population.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Oxigenação Hiperbárica , Idoso , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/estatística & dados numéricos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Estudos Retrospectivos , Esteroides/efeitos adversos
8.
Acta Diabetol ; 56(12): 1315-1321, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493030

RESUMO

AIM: To assess the association between alcohol consumption and/or cigarette smoking with other unhealthy behaviors and clinical cardiovascular risk factors in youth with type 1 diabetes. METHODS: Two hundred and twenty-eight youth with type 1 diabetes (age 13-19 years) were consecutively enrolled in three Regional Pediatric Diabetes Centers in Italy. Demographic, anthropometric, lifestyle (adherence to the Mediterranean diet pattern and sports participation) and laboratory parameters were compared among youth reporting isolated or combined alcohol consumption and/or cigarette smoking. RESULTS: Ten percent of the youth reported alcohol consumption, 10% cigarette smoking and 6% both alcohol and cigarette use; 74% did not report alcohol or cigarette use. Compared to non-drinker non-smoker youth, smokers showed significantly higher percentages of each of the behavioral and clinical cardiovascular risk factors. Drinkers showed a significantly higher proportion of abdominal adiposity, dyslipidemia and poor adherence to the Mediterranean diet. Alcohol consumption was independently associated with both dyslipidemia and high glycosylated hemoglobin. CONCLUSIONS: Our findings emphasize the need to increase the awareness of youth with T1D about the negative impact of alcohol drinking on cardiovascular risk, since the effects of alcohol might be underestimated with respect to the well-known detrimental effects of smoking. Clustering of unhealthy lifestyle should be discouraged in type 1 diabetes youth in order to promote cardiovascular protection.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Fumar Cigarros/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Angiopatias Diabéticas/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Doenças Cardiovasculares/etiologia , Fumar Cigarros/efeitos adversos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/etiologia , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Itália/epidemiologia , Estilo de Vida , Masculino , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Adulto Jovem
9.
Transplant Proc ; 51(8): 2775-2780, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31493915

RESUMO

INTRODUCTION: Most life-threatening diabetes-related complications involve the kidneys, eyes, cardiovascular system, and autonomic nervous system. Clinical islet transplantation (CITx) may be a therapeutic option for some patients. In this study, we analyzed the progression of diabetic complications after CITx and in patients waiting for islet transplantation. METHODS: From 2008 to 2015, 67 patients were listed for pancreatic or islet transplantation. We compared beta scores, islet scores, and secondary complications between patients who underwent islet allotransplantation (CITx group, n = 6) and the patients awaiting islet transplantation (wait group, n = 19) at baseline and during the 1-year follow-up. RESULTS: In the CITx group, good islet function was observed in 80% of patients 1 month post-transplantation and 40% of patients 1 year post-transplantation; however, no patient achieved insulin independence. One patient who underwent simultaneous islet-kidney transplantation died on day 8 because of severe bleeding in the retroperitoneal space. In 1 case, islet primary nonfunction was observed. Mean islet score in the CITx group 1 year post-transplantation was significantly higher than the pretransplant score and wait group scores at enrollment and 1 year later (P < .01). Increased albuminuria was observed in 3 of 11 (27%) patients in the wait group and 0 patients in the CITx group (P = .08). One patient (9%) in the wait group developed chronic renal failure requiring hemodialysis. Ophthalmologic procedures were required by 47% of patients in the wait group and 0 patients in the CITx group in the first year after transplantation (P < .01). CONCLUSION: Successful islet transplantation slows the progression of diabetic complications.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/cirurgia , Insulina , Transplante das Ilhotas Pancreáticas , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Insulina/sangue , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade
10.
Med Arch ; 73(3): 144-148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31402800

RESUMO

Introduction: Previous research found that diabetes mellitus capable to aggravate osteoarthritis disease. In brief, the hyperglycemia condition in diabetes mellitus has an impact on protein glycation of all joint components, including molecule, such as perlecan. The protein expression of perlecan reflects the presence amount of perlecan in the matrix of articular cartilage. However, the impact of hyperglycemia on articular perlecan has not been explained. Moreover, the role of perlecan as a mechanotransducer for chondrocytes in type 1 Diabetes mellitus remains unclear. Aim: This research aims to analyze the effect of hyperglycemia in type 1 Diabetes mellitus to the mRNA level and protein expression of perlecan. Methods: Thirty-five adult male rats were divided into seven groups, such as three groups of rat model with anterior cruciate ligament transection (ACLT) at right knee (ACLT1, ACLT2, ACLT3); three groups of rats with ACLT at right knee which followed by Streptozotocin injection for diabetic mice model (DM1, DM2, DM3); and control group (N). Rat sacrificed at the third week, fourth week, and sixth week after two months of maintenance. The mRNA level and protein expression were analyzed by using PCR and Western blot. All of data was analyzed by ANOVA. Results: Protein expression of perlecan in ACLT mice with diabetes mellitus (DM1, DM2, DM3 group) was gradually decreased according to the increased hyperglycemia duration. Whilst, protein expression of perlecan within ACLT mice without diabetes mellitus (ACLT1, ACLT2, ACLT3 group) was increased. The similar result also demonstrated by the mRNA level of perlecan. Group of DM1, DM2, DM3 exhibited decreased mRNA level of perlecan over the hyperglycemia duration. While, ACLT1, ACLT2, and ACLT3 group had a gradually increased of perlecan mRNA level. Conclusion: Hyperglycemia on osteoarthritic condition decreased mRNA level and protein expression of perlecan which increased the severity of osteoarthritis disease.


Assuntos
Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Tipo 1/sangue , Proteoglicanas de Heparan Sulfato/genética , Proteoglicanas de Heparan Sulfato/metabolismo , Hiperglicemia/sangue , Osteoartrite/metabolismo , Animais , Glicemia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 1/complicações , Modelos Animais de Doenças , Hiperglicemia/etiologia , Masculino , Osteoartrite/complicações , Osteoartrite/genética , RNA Mensageiro/metabolismo , Ratos
11.
Indian J Med Res ; 149(4): 479-488, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31411171

RESUMO

Background & objectives: In contrast to Caucasians of European origin, the aetiology of diabetes mellitus (DM) in young adults in other ethnic groups, including Indians is likely to be heterogeneous and difficult to determine. This study was undertaken to determine the aetiology of diabetes in young Indian adults using a protocol-based set of simple clinical and investigation tools. Methods: In this prospective study, 105 Indian young adults with diabetes (age at onset 18-35 yr; duration <2 yr) were studied for a period of 1-3 years. Pancreatic imaging, fasting C-peptide, islet antibodies (against glutamic acid decarboxylase, tyrosine phosphatase and zinc transporter-8) and mitochondrial A3243G mutational analysis were performed in all patients. Four patients were screened for maturity-onset diabetes of the young (MODY) using next-generation sequencing. Results: Type 1 and type 2 diabetes mellitus (T1DM and T2DM) were equally frequent (40% each), followed by fibrocalculous pancreatic diabetes (FCPD, 15%). Less common aetiologies included MODY (2%), mitochondrial diabetes (1%) and Flatbush diabetes (2%). There was considerable phenotypic overlap between the main aetiological subtypes. Elevated islet antibodies were noted in 62 per cent of T1DM patients [positive predictive value (PPV) 84%; negative predictive value (NPV) 78%] while low plasma C-peptide (<250 pmol/l) was present in 56 per cent of T1DM patients [PPV 96% (after excluding FCPD), NPV 72%]. Using these tests and observing the clinical course over one year, a final diagnosis was made in 103 (99%) patients, while the diagnosis at recruitment changed in 23 per cent of patients. Interpretation & conclusions: The aetiology of diabetes in young adults was heterogeneous, with T1DM and T2DM being equally common. FCPD was also frequent, warranting its screening in Indian patients. Testing for islet antibodies and C-peptide in this age group had good PPV for diagnosis of T1DM.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Adulto , Idade de Início , Peptídeo C/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Índia/epidemiologia , Ilhotas Pancreáticas/patologia , Masculino , Pâncreas/patologia , Estudos Prospectivos , Adulto Jovem
12.
Int J Clin Pract ; 73(11): e13411, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31456268

RESUMO

AIMS: Fear of hypoglycaemia seems to be one of the strongest barrier to physical activity for individuals with type 1 diabetes mellitus (T1DM).The aim of the study was to describe clinical characteristics of participants with T1DM in the intense sporting event of runs and bike rides"SPORTGIVECHANCE-Diabetic runners and cyclists for more sport for all in Europe", and investigate factors associated with self-reported hypoglycaemia episodes during the competition, in particular the use of continuous and flash glucose monitoring systems (CGM/FGM). METHODS: The sporting event took place in Spoleto, Italy from 30 August 2018 to 2 September 2018. An online survey was distributed among 150 participants with diabetes. Only T1DM patients were invited to complete the survey that included questions on baseline clinical characteristics as well as glucose control and meal related issues during the competition. Logistic regression was used to determine factors associated with reported hypoglycaemia. RESULTS: There were 35 T1DM individuals who completed the questionnaire: eight subjects were continuous glucose monitoring system (CGM) users, 10 used flash glucose monitoring systems (FGM), while the others performed self-measured blood glucose measurements (SMBG) on glucose meters. Mild hypoglycaemia episodes during the competition were reported by four CGM/FGM users and six non-users (OR: 0.73, CI: 0.34-1.53). No severe hypoglycaemic episode was reported. Body mass index (BMI) (OR: 1.47, CI: 1.01-2.13) and subjectively very hard or maximal intensity of the competition (OR: 4.90, CI: 1.51-15.89) were associated with a higher risk of hypoglycaemia. CONCLUSIONS: Data obtained from the self-selected sample of T1DM patients suggests that T1DM individuals can participate in intense sport competitions with moderate risk of mild hypoglycaemia regardless of CGM/FGM or SMBG use.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Exercício/fisiologia , Hipoglicemia/sangue , Esportes , Adulto , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de Risco
13.
J Immunol Res ; 2019: 1780567, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467932

RESUMO

This study analyzed the expression of membrane OX40 and OX40L (mOX40 and mOX40L) and levels of soluble OX40 and OX40L (sOX40 and sOX40L) in T1D patients to determine their clinical significance. Peripheral blood (PB) was collected from patients with T1D and healthy control participants. Expression of mOX40 and mOX40L on immune cells was detected by flow cytometry. Levels of sOX40 and sOX40L in sera were measured by ELISA. We demonstrated for the first time enhanced sOX40 and sOX40L expression and reduced mOX40 and mOX40L levels in T1D patients which correlated with the clinical characteristics and inflammatory factors. These results suggest that OX40/OX40L signal may be promising biomarkers and associated with the pathogenesis of T1D.


Assuntos
Diabetes Mellitus Tipo 1/imunologia , Ligante OX40/metabolismo , Receptores OX40/metabolismo , Adolescente , Adulto , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Ligante OX40/sangue , Receptores OX40/sangue , Adulto Jovem
14.
BMC Med ; 17(1): 165, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31438962

RESUMO

BACKGROUND: The objective of this cross-sectional study was to explore the relationship of detectable C-peptide secretion in type 1 diabetes to clinical features and to the genetic architecture of diabetes. METHODS: C-peptide was measured in an untimed serum sample in the SDRNT1BIO cohort of 6076 Scottish people with clinically diagnosed type 1 diabetes or latent autoimmune diabetes of adulthood. Risk scores at loci previously associated with type 1 and type 2 diabetes were calculated from publicly available summary statistics. RESULTS: Prevalence of detectable C-peptide varied from 19% in those with onset before age 15 and duration greater than 15 years to 92% in those with onset after age 35 and duration less than 5 years. Twenty-nine percent of variance in C-peptide levels was accounted for by associations with male gender, late age at onset and short duration. The SNP heritability of residual C-peptide secretion adjusted for gender, age at onset and duration was estimated as 26%. Genotypic risk score for type 1 diabetes was inversely associated with detectable C-peptide secretion: the most strongly associated loci were the HLA and INS gene regions. A risk score for type 1 diabetes based on the HLA DR3 and DQ8-DR4 serotypes was strongly associated with early age at onset and inversely associated with C-peptide persistence. For C-peptide but not age at onset, there were strong associations with risk scores for type 1 and type 2 diabetes that were based on SNPs in the HLA region but not accounted for by HLA serotype. CONCLUSIONS: Persistence of C-peptide secretion varies widely in people clinically diagnosed as type 1 diabetes. C-peptide persistence is influenced by variants in the HLA region that are different from those determining risk of early-onset type 1 diabetes. Known risk loci for diabetes account for only a small proportion of the genetic effects on C-peptide persistence.


Assuntos
Peptídeo C/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/genética , Adolescente , Adulto , Idade de Início , Estudos Transversais , Progressão da Doença , Feminino , Genótipo , Antígenos HLA-DQ/genética , Humanos , Masculino , Fatores de Risco , Adulto Jovem
15.
Asia Pac J Ophthalmol (Phila) ; 8(4): 319-323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369407

RESUMO

PURPOSE: The aims of this study were to correlate diabetic retinopathy (DR) changes with insulin-like growth factor 1 (IGF-1) levels in patients with type 1 diabetes of pubertal age group and to correlate the level of retinopathy with IGF-1 levels. METHODS: This cross-sectional study was done over 2 years and involved patients with type 1 diabetes of age 8 to 25 years. Patients presenting to Ophthalmology OPD and inpatient department along with active recruitment from old pediatrics and endocrinology records were taken for the study. Fasting serum IGF-1 was calculated using enzyme-linked immunosorbent assay technique. Fasting blood sugar levels were taken. Detailed ophthalmic examination was done and DR was noted in all the patients and correlated with IGF-1 levels. RESULTS: A total of 46 patients with type 1 diabetes were recruited into the study. The mean age of the patients was 14.33 ±â€Š4.36 years, with a female-to-male ratio of 3:2. No relationship of IGF-1 with age of onset of diabetes (P = 0.7) or fasting capillary blood glucose (CBG) (P = 0.6) was found, but a significant relationship was found with duration of diabetes (P = 0.001) and low IGF-1 levels (P < 0.0001). CONCLUSIONS: Severity of DR in patients with type 1 diabetes is inversely related to serum IGF-1 levels. Low IGF levels are an indicator for closer follow-up and strict management of diabetes and retinopathy.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Puberdade , Adolescente , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Retinopatia Diabética/etiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Adulto Jovem
16.
BMJ ; 366: l4894, 2019 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462492

RESUMO

OBJECTIVE: To evaluate if the lowest target level for glycated haemoglobin (HbA1c) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes. DESIGN: Population based cohort study. SETTING: Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017. PARTICIPANTS: 10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017. MAIN OUTCOME MEASURES: Relative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA1c. RESULTS: Mean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA1c level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA1c <6.5% (<48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA1c levels 6.5-6.9%, HbA1c levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA1c levels >8.6% (>70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA1c <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005). CONCLUSIONS: Risk of retinopathy and nephropathy did not differ at HbA1c levels <6.5% but increased for severe hypoglycaemia compared with HbA1c levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA1c levels >8.6%, but for milder complications was increased at HbA1c levels >7.0%.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Hemoglobina A Glicada/análise , Hipoglicemia/complicações , Adolescente , Adulto , Glicemia/análise , Glicemia/efeitos dos fármacos , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/etiologia , Retinopatia Diabética/sangue , Retinopatia Diabética/etiologia , Feminino , Seguimentos , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
17.
Nutrients ; 11(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295897

RESUMO

The achievement of optimal post-prandial (PP) glucose control in patients with type 1 diabetes (T1DM) remains a great challenge. This review summarizes the main factors contributing to PP glucose response and discusses the likely reasons why PP glucose control is rarely achieved in T1DM patients. The macronutrient composition of the meal, the rate of gastric emptying and premeal insulin administration are key factors affecting the PP glucose response in T1DM. Although the use of continuous insulin infusion systems has improved PP glucose control compared to conventional insulin therapy, there is still need for further ameliorations. T1DM patients frequently present a delayed gastric emptying (GE) that produces a lower but more prolonged PP hyperglycemia. In addition, delayed GE is associated with a longer time to reach the glycemic peak, with a consequent mismatch between PP glucose elevation and the timing of premeal insulin action. On this basis, including GE time and meal composition in the algorithms for insulin bolus calculation of the insulin delivery systems could be an important step forward for optimization of PP glucose control in T1DM.


Assuntos
Glicemia/fisiologia , Diabetes Mellitus Tipo 1 , Esvaziamento Gástrico/fisiologia , Período Pós-Prandial/fisiologia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/fisiopatologia , Humanos , Insulina/fisiologia , Refeições/fisiologia
18.
Sensors (Basel) ; 19(14)2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31323886

RESUMO

In the daily management of type 1 diabetes (T1D), determining the correct insulin dose to be injected at meal-time is fundamental to achieve optimal glycemic control. Wearable sensors, such as continuous glucose monitoring (CGM) devices, are instrumental to achieve this purpose. In this paper, we show how CGM data, together with commonly recorded inputs (carbohydrate intake and bolus insulin), can be used to develop an algorithm that allows classifying, at meal-time, the post-prandial glycemic status (i.e., blood glucose concentration being too low, too high, or within target range). Such an outcome can then be used to improve the efficacy of insulin therapy by reducing or increasing the corresponding meal bolus dose. A state-of-the-art T1D simulation environment, including intraday variability and a behavioral model, was used to generate a rich in silico dataset corresponding to 100 subjects over a two-month scenario. Then, an extreme gradient-boosted tree (XGB) algorithm was employed to classify the post-prandial glycemic status. Finally, we demonstrate how the XGB algorithm outcome can be exploited to improve glycemic control in T1D through real-time adjustment of the meal insulin bolus. The proposed XGB algorithm obtained good accuracy at classifying post-prandial glycemic status (AUROC = 0.84 [0.78, 0.87]). Consequently, when used to adjust, in real-time, meal insulin boluses obtained with a bolus calculator, the proposed approach improves glycemic control when compared to the baseline bolus calculator. In particular, percentage time in target [70, 180] mg/dL was improved from 61.98 (± 13.89) to 67.00 (± 11.54; p < 0.01) without increasing hypoglycemia.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Algoritmos , Glicemia/efeitos dos fármacos , Automonitorização da Glicemia , Simulação por Computador , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/patologia , Relação Dose-Resposta a Droga , Humanos , Hiperglicemia/sangue , Hiperglicemia/patologia , Sistemas de Infusão de Insulina , Período Pós-Prandial , Estudo de Prova de Conceito
19.
Diabetes Metab Syndr ; 13(2): 1159-1164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336459

RESUMO

AIM: To examine management of diabetes mellitus (DM) and patients' attitude towards DM in a random sample of the adult Greek population. METHODS: s: We selected a random sample of adults with self-reported DM (n = 1002) from a population-based nationwide study using the effective random sampling technique. Collection of data was performed through phone interviews. RESULTS: Prevalence of type 1 DM was 3.5% and of type 2 DM 96.5%. Prevalence of type 1 DM declined while of type 2 DM increased with age. No gender or residency differences were found between type 1 and type 2 DM. A total of 72.0% of subjects with type 2 DM were treated with oral antidiabetic drugs (OAD), 11.5% were treated with insulin and 7.1% were treated with both OAD and insulin. Internists specialized in DM were mainly doctors who started insulin treatment. Almost half of insulin naive subjects were skeptical towards insulin initiation and their main concern was the needle punch. CONCLUSIONS: In a random nationwide sample of the adult population in Greece the majority of subjects with self-reported DM had type 2 DM. Most patients with type 2 were treated with OAD. Almost half of insulin naive subjects were skeptical towards insulin initiation.


Assuntos
Atitude Frente a Saúde , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Dieta para Diabéticos , Exercício , Hipoglicemiantes/uso terapêutico , Autocuidado/psicologia , Adulto , Biomarcadores/análise , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Gerenciamento Clínico , Feminino , Seguimentos , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Inquéritos e Questionários , Adulto Jovem
20.
Diabetes Metab Syndr ; 13(2): 1325-1328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336486

RESUMO

Both admission Blood glucose and previous glycemic state may affect critically ill patients; So Glycemic gap may be a good indicator of ICU outcomes. This study investigated the effect of glycemic gap on short term outcome in critically ill patient and the value of incorporation of the Glycemic Gap into the APACHE-II on its discriminative performance. SUBJECTS AND METHODS: This cross sectional study was conducted in medical ICU of Zagazig University Hospitals, March 2018 to September 2018; total numbers of 240 critically ill patients admitted to ICU were enrolled in. All of them were subjected to: full history taking, clinical examination, routine investigations, random blood sugar, hemoglobin A1c. ADAG, Glycemic Gap and APACHE II were calculated. RESULTS: Elevated glycemic gap was associated with an increased ICU mortality and APACHE-II score was a good predictor of ICU mortality in critically ill patients. CONCLUSIONS: Elevated glycemic gap was significantly associated with an increased ICU mortality that the glycemic gap can be used to assess the severity and prognosis of critically ill patients and their incorporation into the APACHE II score has increased its performance as a predictor of mortality.


Assuntos
Biomarcadores/análise , Estado Terminal/mortalidade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Glicemia/análise , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/etiologia , Hiperglicemia/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Índice de Gravidade de Doença , Taxa de Sobrevida
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