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2.
Ann Intern Med ; 173(10): JC54, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33197347

RESUMO

SOURCE CITATION: Pratley RE, Kanapka LG, Rickels MR, et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020;323:2397-406. 32543682.


Assuntos
Diabetes Mellitus Tipo 1 , Hipoglicemia , Idoso , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemia/prevenção & controle , Insulina
3.
Diabetes Res Clin Pract ; 170: 108479, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002551

RESUMO

BACKGROUND: The self-management of type 1 diabetes (T1DM) has moved forward in many areas over the last 40 years. Our study asked people with T1DM what is their experience of blood glucose (BG) monitoring day to day and how this influences decisions about insulin dosing. METHODS: An on-line self-reported questionnaire containing 44 questions prepared after consultation with clinicians and patients was circulated to people with T1DM 116 responders provided completed responses. Fixed responses were allocated specific values (e.g. not confident = 0 fairly confident = 1). Multivariate regression analysis was carried out. Only those 5 factors with p-value <0.05 were retained. RESULTS: 59% of respondents were >50 years old and 66% had diabetes for >20 years, with 63% of patients reporting HbA1c results ≤8% or 64 mmol/mol. Findings included; 75% used only 1 m; 56% had used the same meter for ≥3 years; 10% had tried flash monitors; 47% were concerned about current BG level; 85% were concerned about long-term impact of higher BG. 72% of respondents keep BG level high to avoid hypoglycaemia; 25% used ≥7 mmol/L as pre-meal BG target to calculate dose; 65% were concerned they might be over/under-dosing; 83% did not discuss accuracy when choosing meter. However 85% were confident in their meter's performance. The factors that linked to LOWER HbA1c included LESS units of basal insulin (p < 0.001), HIGHER number of daily BG tests (p = 0.008), LOWER bedtime blood glucose (p = 0.009), HIGHER patient's concern over long-term impact of high BG (BG) (p < 0.009 but LOWER patient's concern over current BG values (p = 0.009). The final statistical model could explain 41% of the observed variation in HbA1c. CONCLUSION: Many people still run their BG high to avoid hypoglycaemia. Concern about the longer-term consequences of suboptimal glycaemic control was associated with a lower HbA1c and is an area to explore in the future when considering how to help people with T1DM.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Gerenciamento Clínico , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/sangue , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Autorrelato , Autogestão/métodos , Inquéritos e Questionários , Adulto Jovem
4.
Rev Med Liege ; 75(10): 653-659, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030841

RESUMO

Physical activity is a key step in the management of diabetes, both in type 1 and type 2 diabetes. In diabetic subjects, it is recommended to practice 150 minutes of weekly physical activity spread over at least three days, with a maximum of two consecutive days without exercise. However, more than 60 % of type 1 diabetic patients fail to meet this goal. This is largely explained by the fear of potential adverse effects, in particular the occurrence of hypoglycaemia during exercise, which represents a major obstacle to its safe practice. Therefore, specific therapeutic education should be considered in these subjects in order to promote regular physical activity.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglicemia , Esportes , Diabetes Mellitus Tipo 1/terapia , Exercício Físico , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle
5.
Tokai J Exp Clin Med ; 45(3): 139-143, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901903

RESUMO

OBJECTIVE: The Japan Diabetes Society and the Japan Gerontological Society Collaborative Committee recently released guidelines for the management of elderly diabetes patients. In these guidelines, patients are classified into categories I-III depending on age, cognitive function, activities of daily living (ADL), and presence or absence of multiple functional impairments. The target control value of HbA1c is set for each category. Low (< 30 mL/min/1.73 m2) estimated glomerular filtration rate (eGFR) is an independent highrisk factor for severe hypoglycemia, yet it is not included in the categorization factors. We surveyed elderly diabetes patients with normal cognitive function and ADL (Category I) who were admitted to the emergency department with severe hypoglycemia, retrospectively studied eGFR at the onset of hypoglycemic episode, and checked whether the HbA1c levels matched the guidelines. METHODS: Among 129 diabetes patients aged ≥ 65 years admitted to the Tokai University hospital for hypoglycemic emergencies, 73 had normal cognitive function and ADL. HbA1c level and eGFR at the onset of hypoglycemic attack were obtained from the medical records of these subjects. RESULTS: All subjects were prescribed anti-diabetes agents with high-risk of severe hypoglycemia, including insulin. Sixty-one patients showed eGFR ≥ 30 mL/min/1.73 m2. Among them, 31 (50.8%) had HbA1c levels below the recommended range. Among 12 patients whose eGFR < 30 mL/min/1.73 m2, 6 (50%) had HbA1c levels below the recommended range. CONCLUSION: Even with normal cognitive function and ADL, eGFR < 30 mL/min/1.73 m2 a lone i s a s trong risk factor for hypoglycemia in elderly diabetes patients. We propose that the target control HbA1c level in elderly patients with eGFR < 30 mL/min/1.73 m2 should be 7.5-8.4 %, which is equivalent to that of category III patients.


Assuntos
Complicações do Diabetes , Taxa de Filtração Glomerular , Hipoglicemia/diagnóstico , Hipoglicemia/prevenção & controle , Idoso , Biomarcadores/sangue , Feminino , Hemoglobina A Glicada , Humanos , Hipoglicemia/etiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
6.
BMC Psychol ; 8(1): 82, 2020 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-32771061

RESUMO

BACKGROUND: The fear of hypoglycemia leads to psychological symptoms in patients with diabetes type 2. In this research, the effects of EDMR on the fear of hypoglycemia in patients with diabetes type 2 were examined. METHODS: A clinical trial study was carried out with participation of 72 patients who had diabetes type 2 in Velayat Hospital. The participants were randomly assigned into control and intervention groups. The intervention group received EMDR. The required information was gleaned using a questionnaire of fear of hypoglycemia, intensity of hypoglycemia, and demographics filled out before the intervention, and 1 month and 3 months after it. The data were analyzed using descriptive statistics on SPSS Version 23. For comparison of fear of hypoglycemia in intervention and control groups, repeated measure ANOVA and Cohen d test were used. RESULTS: The mean age of the participants in the intervention group was 43.17 ± 10.55 and in the control group was 45.86 ± 13.6. In this study, without considering the potential disruptors in the incorrect model, the intervention caused a reduction of 15 points 1 month after the completion of the intervention and a reduction of 17 points 3 month after the completion of the intervention on the scale of fear of hypoglycemia; but post-correction of potential disruptors, intervention caused a reduction of 19.5 scores 1 month after the completion and a reduction of 20.3 scores 3 months after the intervention . CONCLUSIONS: The EMDR can be used as a non-pharmaceutical treatment method to treat and alleviate the fear of hypoglycemia in type 2 diabetes patients. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20181201041813N1 , 2019/11/13.


Assuntos
Diabetes Mellitus Tipo 2 , Dessensibilização e Reprocessamento através dos Movimentos Oculares , Medo , Hipoglicemia , Adulto , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Movimentos Oculares , Feminino , Humanos , Hipoglicemia/etiologia , Hipoglicemia/prevenção & controle , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
7.
PLoS One ; 15(8): e0238094, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822414

RESUMO

INTRODUCTION: Hypoglycemia is a true medical emergency, which needs prompt recognition and treatment to prevent organ damage and mortality. Knowledge about the prevention of hypoglycemia is an important step to self-care practice because informed people are more likely to have a better hypoglycemia prevention practice. The aim of this study was to explore hypoglycemia prevention practice and its associated factors among diabetes patients at a university teaching hospital in Ethiopia. METHOD: A cross-sectional study was carried out on a total of 422 systematically selected diabetic patients at the University of Gondar Referral and Teaching Hospital. Data were collected using a pre-tested, structured, and interviewer-administered questionnaire. The collected data was analyzed by SPSS version 20 and associated variables were measured using binary logistic regression and within 95% confidence interval. A p-value <0.05 was considered as statistically significant. RESULT: From the total of 422 diabetic patients, 61.6% were males, 70.1% of them were urban dwellers, 37.9% of them were unable to write and read, and 70.6% of the participants were taking insulin. The majority of respondents had good knowledge of (77.5%) and practice of (93.1%) hypoglycemia prevention. Only good participant knowledge about hypoglycemia prevention was strongly associated with the practice of its prevention (AOR: 2.87 (1.2-6.8), p = 0.01). CONCLUSION AND RECOMMENDATION: Even though diabetic patients with good knowledge of hypoglycemia and its prevention was strongly associated with good prevention practice, there exists a gap in knowledge of hypoglycemia prevention. Hence, we recommend counseling be offered to patients regarding hypoglycemia during their visit to the diabetic clinic. Counseling points such as common clinical symptoms, its negative consequence, as well as remedial options are essential elements for the improvement of their practice on its prevention.


Assuntos
Diabetes Mellitus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hipoglicemia/prevenção & controle , Adolescente , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/patologia , Etiópia , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Autocuidado , Inquéritos e Questionários , Adulto Jovem
8.
Diabetes Res Clin Pract ; 166: 108348, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32711000

RESUMO

INTRODUCTION: The COVID-19 pandemic has forced governments to take exceptional measures to minimize its spread, imposing lockdown policies. The aim of this study was to evaluate the impact of lockdown on type 1 diabetes (T1D) glycemic control. MATERIAL AND METHODS: People with T1D using flash glucose monitoring were included. Data from the 14 days before lockdown were compared with data from the last 14 days after 8 weeks of lockdown. RESULTS: A total of 307 patients were included (age 45.8 ± 12.6 years, 50.2% male, diabetes duration 21.1 ± 12.3 years). Only one patient had COVID-19 infection. Mean glucose decreased from 166.89 ± 29.4 to 158.0 ± 29.0 mg/dL and estimated HbA1c declined from 7.4 ± 1.0 to 7.1 ± 1.0% (54 ± 10.9 vs 57 ± 10.9 mmol/mol; p < 0.001). Time in range increased from 57.8 ± 15.8 to 62.46 ± 16.1%. Time in hyperglycemia > 180 mg/dL and >250 mg/dL decreased from 37.3 ± 1.9% to 32.0 ± 17.1% and from 13.0 ± 11.3 to 10.3 ± 10.6%, respectively; (p < 0.001). Time in hypoglycaemia <70 mg/dL increased from 4.9 ± 4.0% to 5.5 ± 4.4% (p < 0.001). No differences in time <54 mg/dl, coefficient of variation (CV%) or number of scans per day were found. CONCLUSION: Despite the limitations of lockdown, glycemic control improved in patients with T1D. These results suggest that having more time for self-management may help improve glycemic control in the short term.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Insulina/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Automonitorização da Glicemia/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/virologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Espanha/epidemiologia
9.
Sci Rep ; 10(1): 10718, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32612144

RESUMO

The heterogeneity of critical illness complicates both clinical trial design and real-world management. This complexity has resulted in conflicting evidence and opinion regarding the optimal management in many intensive care scenarios. Understanding this heterogeneity is essential to tailoring management to individual patients. Hyperglycaemia is one such complication in the intensive care unit (ICU), accompanied by decades of conflicting evidence around management strategies. We hypothesized that analysis of highly-detailed electronic medical record (EMR) data would demonstrate that patients vary widely in their glycaemic response to critical illness and response to insulin therapy. Due to this variability, we believed that hyper- and hypoglycaemia would remain common in ICU care despite standardised approaches to management. We utilized the Medical Information Mart for Intensive Care III v1.4 (MIMIC) database. We identified 19,694 admissions between 2008 and 2012 with available glucose results and insulin administration data. We demonstrate that hyper- and hypoglycaemia are common at the time of admission and remain so 1 week into an ICU admission. Insulin treatment strategies vary significantly, irrespective of blood glucose level or diabetic status. We reveal a tremendous opportunity for EMR data to guide tailored management. Through this work, we have made available a highly-detailed data source for future investigation.


Assuntos
Biomarcadores/sangue , Glicemia/análise , Estado Terminal/terapia , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Idoso , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/etiologia , Hiperglicemia/metabolismo , Hipoglicemia/etiologia , Hipoglicemia/metabolismo , Masculino , Prognóstico , Estudos Retrospectivos
10.
Curr Diab Rep ; 20(8): 34, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32562097

RESUMO

PURPOSE OF REVIEW: To provide an update on glycemic management of type 1 diabetes during breastfeeding with focus on diet and insulin treatment to prevent hypoglycemia, ketoacidosis, and weight retention. Recommendations for insulin pump settings are given. RECENT FINDINGS: Women with type 1 diabetes are encouraged to breastfeed. Hypoglycemia is a concern in the breastfeeding period among women with type 1 diabetes, and ketoacidosis may also occur. The usual goals for glucose values for persons with diabetes also apply during breastfeeding. The recommended minimum daily carbohydrate intake is 210 g during breastfeeding, and this may contribute to prevention of hypoglycemia and ketoacidosis while aiming for gradual weight loss. Insulin requirements are 21% lower during breastfeeding than before pregnancy. Diabetes management in breastfeeding women with type 1 diabetes includes the same goals for glucose values as in other persons with diabetes, sufficient carbohydrate intake, and adequate reduction in insulin dose.


Assuntos
Diabetes Mellitus Tipo 1 , Cetoacidose Diabética , Hipoglicemia , Glicemia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Humanos , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Sistemas de Infusão de Insulina , Gravidez
11.
Diving Hyperb Med ; 50(2): 135-143, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32557415

RESUMO

Diving by persons with diabetes has long been conducted, with formal guidelines published in the early 1990s. Subsequent consensus guidelines produced following a 2005 workshop helped to advance the recognition of relevant issues and promote discussion. The guidelines were intended as an interim step in guidance, with the expectation that revisions should follow the gathering of additional data and experience. Recent and ongoing developments in pharmacology and technology can further aid in reducing the risk of hypoglycemia, a critical acute concern of diving with diabetes. Careful and periodic evaluation remains crucial to ensure that participation in diving activity is appropriate. Close self-monitoring, thoughtful adjustments of medications and meals, and careful review of the individual response to diving can assist in optimising control and ensuring safety. Open communication with diving partners, support personnel, and medical monitors is important to ensure that all are prepared to effectively assist in case of need. Ongoing vigilance, best practice, including graduated clearance for diving exposures and adverse event reporting, are all required to ensure the safety of diving with diabetes and to promote community understanding and acceptance.


Assuntos
Diabetes Mellitus Tipo 2 , Mergulho , Hipoglicemia , Mergulho/fisiologia , Humanos , Hipoglicemia/etiologia , Hipoglicemia/prevenção & controle
12.
JAMA ; 323(23): 2397-2406, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32543682

RESUMO

Importance: Continuous glucose monitoring (CGM) provides real-time assessment of glucose levels and may be beneficial in reducing hypoglycemia in older adults with type 1 diabetes. Objective: To determine whether CGM is effective in reducing hypoglycemia compared with standard blood glucose monitoring (BGM) in older adults with type 1 diabetes. Design, Setting, and Participants: Randomized clinical trial conducted at 22 endocrinology practices in the United States among 203 adults at least 60 years of age with type 1 diabetes. Interventions: Participants were randomly assigned in a 1:1 ratio to use CGM (n = 103) or standard BGM (n = 100). Main Outcomes and Measures: The primary outcome was CGM-measured percentage of time that sensor glucose values were less than 70 mg/dL during 6 months of follow-up. There were 31 prespecified secondary outcomes, including additional CGM metrics for hypoglycemia, hyperglycemia, and glucose control; hemoglobin A1c (HbA1c); and cognition and patient-reported outcomes, with adjustment for multiple comparisons to control for false-discovery rate. Results: Of the 203 participants (median age, 68 [interquartile range {IQR}, 65-71] years; median type 1 diabetes duration, 36 [IQR, 25-48] years; 52% female; 53% insulin pump use; mean HbA1c, 7.5% [SD, 0.9%]), 83% used CGM at least 6 days per week during month 6. Median time with glucose levels less than 70 mg/dL was 5.1% (73 minutes per day) at baseline and 2.7% (39 minutes per day) during follow-up in the CGM group vs 4.7% (68 minutes per day) and 4.9% (70 minutes per day), respectively, in the standard BGM group (adjusted treatment difference, -1.9% (-27 minutes per day); 95% CI, -2.8% to -1.1% [-40 to -16 minutes per day]; P <.001). Of the 31 prespecified secondary end points, there were statistically significant differences for all 9 CGM metrics, 6 of 7 HbA1c outcomes, and none of the 15 cognitive and patient-reported outcomes. Mean HbA1c decreased in the CGM group compared with the standard BGM group (adjusted group difference, -0.3%; 95% CI, -0.4% to -0.1%; P <.001). The most commonly reported adverse events using CGM and standard BGM, respectively, were severe hypoglycemia (1 and 10), fractures (5 and 1), falls (4 and 3), and emergency department visits (6 and 8). Conclusions and Relevance: Among adults aged 60 years or older with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in hypoglycemia over 6 months. Further research is needed to understand the long-term clinical benefit. Trial Registration: ClinicalTrials.gov Identifier: NCT03240432.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Hemoglobina A Glicada/análise , Hipoglicemia/prevenção & controle , Idoso , Automonitorização da Glicemia/instrumentação , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Medidas de Resultados Relatados pelo Paciente
13.
JAMA ; 323(23): 2388-2396, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32543683

RESUMO

Importance: Adolescents and young adults with type 1 diabetes exhibit the worst glycemic control among individuals with type 1 diabetes across the lifespan. Although continuous glucose monitoring (CGM) has been shown to improve glycemic control in adults, its benefit in adolescents and young adults has not been demonstrated. Objective: To determine the effect of CGM on glycemic control in adolescents and young adults with type 1 diabetes. Design, Setting, and Participants: Randomized clinical trial conducted between January 2018 and May 2019 at 14 endocrinology practices in the US including 153 individuals aged 14 to 24 years with type 1 diabetes and screening hemoglobin A1c (HbA1c) of 7.5% to 10.9%. Interventions: Participants were randomized 1:1 to undergo CGM (CGM group; n = 74) or usual care using a blood glucose meter for glucose monitoring (blood glucose monitoring [BGM] group; n = 79). Main Outcomes and Measures: The primary outcome was change in HbA1c from baseline to 26 weeks. There were 20 secondary outcomes, including additional HbA1c outcomes, CGM glucose metrics, and patient-reported outcomes with adjustment for multiple comparisons to control for the false discovery rate. Results: Among the 153 participants (mean [SD] age, 17 [3] years; 76 [50%] were female; mean [SD] diabetes duration, 9 [5] years), 142 (93%) completed the study. In the CGM group, 68% of participants used CGM at least 5 days per week in month 6. Mean HbA1c was 8.9% at baseline and 8.5% at 26 weeks in the CGM group and 8.9% at both baseline and 26 weeks in the BGM group (adjusted between-group difference, -0.37% [95% CI, -0.66% to -0.08%]; P = .01). Of 20 prespecified secondary outcomes, there were statistically significant differences in 3 of 7 binary HbA1c outcomes, 8 of 9 CGM metrics, and 1 of 4 patient-reported outcomes. The most commonly reported adverse events in the CGM and BGM groups were severe hypoglycemia (3 participants with an event in the CGM group and 2 in the BGM group), hyperglycemia/ketosis (1 participant with an event in CGM group and 4 in the BGM group), and diabetic ketoacidosis (3 participants with an event in the CGM group and 1 in the BGM group). Conclusions and Relevance: Among adolescents and young adults with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in glycemic control over 26 weeks. Further research is needed to understand the clinical importance of the findings. Trial Registration: ClinicalTrials.gov Identifier: NCT03263494.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/sangue , Hemoglobina A Glicada/análise , Hipoglicemiantes/administração & dosagem , Adolescente , Glicemia/análise , Automonitorização da Glicemia/instrumentação , Diabetes Mellitus Tipo 1/tratamento farmacológico , Cetoacidose Diabética , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/prevenção & controle , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Masculino , Aplicativos Móveis , Monitorização Ambulatorial/instrumentação , Adulto Jovem
14.
Diabet Med ; 37(7): 1094-1102, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32333691

RESUMO

The month of Ramadan forms one of the five pillars of the Muslim faith. Adult Muslims are obligated to keep daily fasts from dawn to sunset, with exceptions. This year Ramadan is due to begin on 23 April 2020 and the longest fast in the UK will be approximately 18 hours in length. In addition, due to the often high-calorie meals eaten to break the fast, Ramadan should be seen as a cycle of fasting and feasting. Ramadan fasting can impact those with diabetes, increasing the risk of hypoglycaemia, hyperglycaemia and dehydration. This year, Ramadan will occur during the global COVID-19 pandemic. Reports show that diabetes appears to be a risk factor for more severe disease with COVID-19. In addition, the UK experience has shown diabetes and COVID-19 is associated with dehydration, starvation ketosis, diabetic ketoacidosis and hyperosmolar hyperglycaemic state. This makes fasting in Ramadan particularly challenging for those Muslims with diabetes. Here, we discuss the implications of fasting in Ramadan during the COVID-19 pandemic and make recommendations for those with diabetes who wish to fast.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Jejum/metabolismo , Férias e Feriados , Islamismo , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/metabolismo , Desidratação/epidemiologia , Desidratação/metabolismo , Desidratação/prevenção & controle , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Cetoacidose Diabética/epidemiologia , Dietoterapia , Gerenciamento Clínico , Jejum/efeitos adversos , Hidratação , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/metabolismo , Hiperglicemia/prevenção & controle , Coma Hiperglicêmico Hiperosmolar não Cetótico/epidemiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/metabolismo , Hipoglicemia/epidemiologia , Hipoglicemia/metabolismo , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Cetose/epidemiologia , Cetose/metabolismo , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/metabolismo , Medição de Risco , Reino Unido
15.
Sci Rep ; 10(1): 4095, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32139733

RESUMO

Treatment guidelines for type 2 diabetes (T2D) recommend avoidance of hypoglycemia and less stringent glycemic control in older patients. We examined the relation of glycemic control to glucose-lowering medications use in a cohort of patients aged>80 years with a diagnosis of T2D and a hospital admission in the Capital Region of Denmark in 2012-2016. We extracted data on medication use, diagnoses, and biochemistry from the hospitals' records. We identified 5,172 T2D patients with high degree of co-morbidity and where 17% had an HbA1c in the range recommended for frail, comorbid, older patients with type 2 diabetes (58-75 mmol/mol (7.5-9%)). Half of the patients (n = 2,575) had an HbA1c <48 mmol/mol (<6.5%), and a majority of these (36% of all patients) did not meet the diagnostic criteria for T2D. Of patients treated with one or more glucose-lowering medications (n = 1,758), 20% had HbA1c-values <42 mmol/mol (<6%), and 1% had critically low Hba1c values <30 mmol/mol (<4.9%), In conclusion, among these hospitalized T2D patients, few had an HbA1c within the generally recommended glycemic targets. One third of patients did not meet the diagnostic criteria for T2D, and of the patients who were treated with glucose-lowering medications, one-fifth had HbA1c-values suggesting overtreatment.


Assuntos
Biomarcadores/análise , Glicemia/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/análise , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/patologia , Feminino , Seguimentos , Humanos , Masculino , Admissão do Paciente/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos
16.
Dtsch Med Wochenschr ; 145(5): 314-317, 2020 03.
Artigo em Alemão | MEDLINE | ID: mdl-32120406

RESUMO

CLINICAL HISTORY AND FINDINGS: A patient with T1DM, panic disorder and hypoglycaemia fear diabetes duration 4 years, BMI 25. 6, was treated in the day clinic psychosomatics with a multimodal treatment approach. She reports severe fear of hypoglycaemia and repeated hypoglycaemia. Fearing hypoglycaemia, the patient changed her diabetes self-management and thus experienced limitations in her everyday functionality. DIAGNOSIS: Diabetes mellitus type 1, panic disorder and exaggerated fear of hypoglycaemia. THERAPY: The combination of continuous glucose monitoring (CGM) and a symptom record diary from classical cognitive-behavioural therapy (CBT) and in addition a multimodal psychotherapeutic group intervention based on Acceptance and Commitmenttherapy (ACT) were applied. The patient learned to differentiate between symptoms of panic attacks and symptoms due to low blood glucose levels. CONCLUSION: The combination of psychotherapeutic measures with CGM appears to be a helpful approach to the treatment of disease-specific mental disorders in diabetes mellitus.


Assuntos
Automonitorização da Glicemia , Terapia Cognitivo-Comportamental , Diabetes Mellitus Tipo 1/complicações , Hipoglicemia , Transtorno de Pânico , Adulto , Ansiedade/complicações , Ansiedade/terapia , Glicemia/análise , Medo/psicologia , Feminino , Humanos , Hipoglicemia/complicações , Hipoglicemia/prevenção & controle , Hipoglicemia/psicologia , Transtorno de Pânico/complicações , Transtorno de Pânico/terapia
17.
Diabetes Care ; 43(4): 799-805, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32144167

RESUMO

OBJECTIVE: Insulin dosing in type 1 diabetes (T1D) is oftentimes complicated by fluctuating insulin requirements driven by metabolic and psychobehavioral factors impacting individuals' insulin sensitivity (IS). In this context, smart bolus calculators that automatically tailor prandial insulin dosing to the metabolic state of a person can improve glucose management in T1D. RESEARCH DESIGN AND METHODS: Fifteen adults with T1D using continuous glucose monitors (CGMs) and insulin pumps completed two 24-h admissions in a hotel setting. During the admissions, participants engaged in an early afternoon 45-min aerobic exercise session, after which they received a standardized dinner meal. The dinner bolus was computed using a standard bolus calculator or smart bolus calculator informed by real-time IS estimates. Glucose control was assessed in the 4 h following dinner using CGMs and was compared between the two admissions. RESULTS: The IS-informed bolus calculator allowed for a reduction in postprandial hypoglycemia as quantified by the low blood glucose index (2.02 vs. 3.31, P = 0.006) and percent time <70 mg/dL (8.48% vs. 15.18%, P = 0.049), without increasing hyperglycemia (high blood glucose index: 3.13 vs. 2.09, P = 0.075; percent time >180 mg/dL: 13.24% vs. 10.42%, P = 0.5; percent time >250 mg/dL: 2.08% vs. 1.19%, P = 0.317). In addition, the number of hypoglycemia rescue treatments was reduced from 12 to 7 with the use of the system. CONCLUSIONS: The study shows that the proposed IS-informed bolus calculator is safe and feasible in adults with T1D, appropriately reducing postprandial hypoglycemia following an exercise-induced IS increase.


Assuntos
Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Cálculos da Dosagem de Medicamento , Exercício Físico/fisiologia , Hipoglicemia/prevenção & controle , Sistemas de Infusão de Insulina , Resistência à Insulina/fisiologia , Insulina/administração & dosagem , Adulto , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/fisiopatologia , Desenho de Equipamento , Feminino , Humanos , Hiperglicemia/sangue , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Masculino , Refeições , Pessoa de Meia-Idade , Período Pós-Prandial/efeitos dos fármacos , Adulto Jovem
19.
Rev Med Suisse ; 16(680): 264-267, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022491

RESUMO

Considering the progressive nature of type 2 diabetes, glycated hemoglobin (HbA1c) goals and treatment plans should be regularly tailored to the patient's need to prevent hypoglycemia. There are individual HbA1c target levels that take into account factors such as age, comorbidity, and risks of treatment. The emergence of new therapeutic classes reducing hypoglycemia has changed ongoing practices. This article presents a potentially preventable case of a patient with hypoglycemia and reflects on the latest European and American recommendations for antidiabetic treatment in elderly patients.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Administração Oral , Idoso , Glicemia/efeitos dos fármacos , Hemoglobina A Glicada/análise , Humanos
20.
BMC Endocr Disord ; 20(1): 16, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992275

RESUMO

BACKGROUND: Strict glycaemic control early in the treatment process has been shown to reduce the occurrence of micro- and macro- vascular complications of diabetes in the long-term. Thus, treatment guidelines advise early intensification of treatment to achieve glycaemic control goals. However, evidence in Greece suggests that, despite guideline recommendations, glycaemic control among patients with T2DM remains challenging. This study presents the demographic and clinical characteristics of patients with T2DM in Greece using data from an electronic registry designed specifically for this treatment category and investigates the factors that are independently associated with glycaemic control. METHODS: This is a multi-center, observational, cross-sectional study to investigate epidemiological and clinical factors affecting glycaemic control among patients with T2DM in Greece. Data was collected via a web-based disease registry, the Diabetes Registry, which operated from January 1st to December 31st, 2017. Five large specialized diabetes centers operating in Greek hospitals participated in the study. RESULTS: Data for 1141 patients were retrieved (aged 63.02 ± 12.65 years, 56.9% male). Glycaemic control (Hb1Ac < 7%) was not achieved in 57.1% of patients. Factors independently associated with poor glycaemic control were: family history of diabetes [OR: 1.53, 95% CI: 1.06-2.23], BMI score between 25 to 30 [OR: 2.08, 95% CI: 1.05-4.13] or over 30 [OR: 2.12, 95% CI 1.12-4.07], elevated LDL levels [OR: 1.53, 95% 1.06-2.21] and low HDL levels [OR: 2.12, 95% CI: 1.44-3.12]. Lastly, use of injectable antidiabetic agents (in monotherapy or in combination) was less likely to be associated with poor glycaemic control versus treatment with combination of oral and injectable agents [OR: 0.50, 95% CI: 0.24-1.01]. This association was found to be marginally statistically significant. CONCLUSION: Inadequate lipid control, family history of diabetes and presence of obesity (ΒΜΙ ≥ 30 kg/m2) were associated with poor glycaemic control among study sample, whereas use of injectable antidiabetic agents was less likely to be associated with poor glycaemic control. These findings indicate how complex optimal glycaemic control is, highlighting the need for tailored interventions in high-risk subpopulations with T2DM.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Glicemia/análise , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/patologia , Hipoglicemia/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros
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