Insulin therapy in type 1 diabetes

Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study

OBJECTIVES

To estimate the burden, trends, and inequalities of type 1 diabetes mellitus (T1DM) among older adults at global, regional, and national level from 1990 to 2019.

DESIGN

Population based study.

POPULATION

Adults aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2019)from 1990 to 2019.

MAIN OUTCOME MEASURES

Primary outcomes were T1DM related age standardised prevalence, mortality, disability adjusted life years (DALYs), and average annual percentage change.

RESULTS

The global age standardised prevalence of T1DM among adults aged ≥65 years increased from 400 (95% uncertainty interval (UI) 332 to 476) per 100 000 population in 1990 to 514 (417 to 624) per 100 000 population in 2019, with an average annual trend of 0.86% (95% confidence interval (CI) 0.79% to 0.93%); while mortality decreased from 4.74 (95% UI 3.44 to 5.9) per 100 000 population to 3.54 (2.91 to 4.59) per 100 000 population, with an average annual trend of -1.00% (95% CI -1.09% to -0.91%), and age standardised DALYs decreased from 113 (95% UI 89 to 137) per 100 000 population to 103 (85 to 127) per 100 000 population, with an average annual trend of -0.33% (95% CI -0.41% to -0.25%). The most significant decrease in DALYs was observed among those aged <79 years: 65-69 (-0.44% per year (95% CI -0.53% to -0.34%)), 70-74 (-0.34% per year (-0.41% to -0.27%)), and 75-79 years (-0.42% per year (-0.58% to -0.26%)). Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index (-2.17% per year (95% CI -2.31% to -2.02%) v -0.16% per year (-0.45% to 0.12%)). While the highest prevalence remained in high income North America, Australasia, and western Europe, the highest DALY rates were found in southern sub-Saharan Africa, Oceania, and the Caribbean. A high fasting plasma glucose level remained the highest risk factor for DALYs among older adults during 1990-2019.

CONCLUSIONS

The life expectancy of older people with T1DM has increased since the 1990s along with a considerable decrease in associated mortality and DALYs. T1DM related mortality and DALYs were lower in women aged ≥65 years, those living in regions with a high sociodemographic index, and those aged <79 years. Management of high fasting plasma glucose remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed.

[Predictive factors for the level of knowledge, attitudes and quality of life of Tunisian diabetics : 1007 cases]

AIM OF THE STUDY

To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics POPULATION AND METHODS: We undertook an analytical cross-sectional study. The questionnaire was administered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Knowledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life.

RESULTS

We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabetes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D.

CONCLUSION

Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations.

The emotional well-being of parents with children at genetic risk for type 1 diabetes before and during participation in the POInT-study

INTRODUCTION

This study examined the emotional impact that parents experience when confronted with an increased genetic risk of type 1 diabetes (T1D) in their child. Population-based screening of neonates for genetic risk of chronic disease carries the risk of increased emotional burden for parents.

METHODS

Information was collected using a well-being questionnaire for parents of infants identified as having an increased risk for T1D in a multinational research study. Parents were asked to complete this questionnaire after they were told their child had an increased risk for T1D (Freder1k-study) and at several time points during an intervention study (POInT-study), where oral insulin was administered daily.

RESULTS

Data were collected from 2595 parents of 1371 children across five countries. Panic-related anxiety symptoms were reported by only 4.9% after hearing about their child having an increased risk. Symptoms of depression were limited to 19.4% of the parents at the result-communication visit and declined over time during the intervention study. When thinking about their child's risk for developing T1D (disease-specific anxiety), 47.2% worried, felt nervous and tense. Mothers and parents with a first-degree relative (FDR) with T1D reported more symptoms of depression and disease-specific anxiety (p < 0.001) than fathers and parents without a FDR.

CONCLUSION

Overall, symptoms of depression and panic-related anxiety are comparable with the German population. When asked about their child's risk for T1D during the intervention study, some parents reported disease-specific anxiety, which should be kept in mind when considering population-based screening. As certain subgroups are more prone, it will be important to continue psychological screening and, when necessary, to provide support by an experienced, multidisciplinary team.

Skin Involvement in Paediatric Patients with Type 1 Diabetes

Skin involvement is an overlooked aspect in the management of paediatric patients with type 1 diabetes. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: "children," "pediatric/paediatric patients," "skin," "skin disorders," "type 1 diabetes." Dermatological side effects are frequently observed among diabetic children and adolescents. Insulin-induced lipodystrophies and allergic contact dermatitis caused by insulin pumps or glycaemic sensors are the most common skin reactions in these patients. Furthermore, several diabetes-associated skin diseases such as necrobiosis lipoidica, granuloma annulare, vitiligo, and bullosis diabeticorum may already be present in paediatric patients. Paediatric diabetes specialists should pay attention to their patients' skin to recognize these disorders, identify the potential causes, and choose the most suitable treatment. Finally, the evaluation of skin concentrations of advanced glycation end-products using non-invasive diagnostic techniques may be used to assess the risk of chronic complications of diabetes as early as adolescence.

Replacing Pumps with Light Controlled Insulin Delivery

PURPOSE OF REVIEW

The aim of this review is to summarize the development of the photoactivated depot (PAD) approach for the minimally invasive and continuously variable delivery of insulin.

RECENT FINDINGS

Using an insulin PAD, we have demonstrated that we can release native, bioactive insulin into diabetic animals in response to light signals from a small external LED light source. We have further shown that this released insulin retains bioactivity and reduces blood glucose. In addition, we have designed and constructed second generation materials that have high insulin densities, with the potential for multiple day delivery. The PAD approach for insulin therapy holds promise for addressing the pressing need for continuously variable delivery methods that do not rely on pumps, and their myriad associated problems.

Trends in the use and cost of human and analogue insulins in a Colombian population, 2011-2015

OBJECTIVES

Diabetes mellitus is a common disease among the general population and imposes considerable costs on health care systems. Insulin is used to treat type 1 diabetes mellitus and as an adjuvant to oral agents in advanced stages of type 2 diabetes mellitus. The objective was to describe the trends in use and cost of human and analogue insulins for Colombian patients.

STUDY DESIGN

Descriptive retrospective analysis of prescriptions of human and analogue insulins on a monthly basis for the period from July 1, 2011 to February 2, 2015.

METHODS

Information was collected for the database population of two insurance companies. Frequencies and proportions were calculated; estimated economic impact was expressed as net cost and cost per thousand inhabitants per day.

RESULTS

During the observation period, there was continuous growth in use of insulin, mainly in analogue forms (34.0% growth). At the start of the study, 10.4% of subjects were using an analogue insulin; this figure was 62.6% at the end of the study. In 2012, the average cost per 1000 inhabitants/day was US$1.7 for analogue and US$0.8 for human insulins. At the end of the observation period these costs had risen to US$9.2 for analogue (441.1% increase) and fallen to US$0.5 for human insulin (58.3% decrease).

CONCLUSIONS

There has been an increase in the unit cost and frequency of use of insulin analogues for anti-diabetic therapy in Colombian patients. Moreover, there is controversy over whether insulin analogues are a more cost-effective treatment than human insulins for the general diabetic population.

HGF/C-MET PATHWAY HAS A ROLE IN TESTICULAR DAMAGE IN DIABETES INDUCED BY STREPTOZOTOCIN

Objective

The aim of the study was to investigate the role of Hepatocyte Growth Factor (HGF)/c-Met pathway in testicular damage provoked by streptozotocin (STZ)- induced diabetes and the effects of insulin treatment on the HGF/c-Met pathway.

Methods

Total 21 paraffin-embedded testicular tissues of control (n=7), streptozotocin (STZ)-induced diabetic (n=7) and insulin-treated diabetic (n=7) Wistar albino rats were used in this study. Testicular damage was examined histologically and by Johnsen's score was also evaluated. Immunohistochemical stainings of HGF and c-Met were analysed by using antibodies against HGF and c-Met.

Results

We found the degeneration in seminiferous tubule epithelium and disorganization of spermatogenetic cell series in testis tissues of diabetic rats. We also determined decrease both in seminiferous tubule diameter and Johnsen's scores in diabetic group. The expressions of HGF and c-Met in seminiferous tubule epithelium and in spermatogenic cells (especially spermatocytes and spermatids) were significantly increased in diabetic rats compared to those of control. Insulin treatment significantly reduced the diabetes-induced morphological changes and HGF/c-Met over expressions in the diabetic rat testis.

Conclusion

HGF/c-Met pathway might have a role in diabetes- induced testicular damage. Drugs acting on this pathway might be effective to prevent or delay the testicular damage induced by diabetes.

Light Control of Insulin Release and Blood Glucose Using an Injectable Photoactivated Depot

In this work we demonstrate that blood glucose can be controlled remotely through light stimulated release of insulin from an injected cutaneous depot. Human insulin was tethered to an insoluble but injectable polymer via a linker, which was based on the light cleavable di-methoxy nitrophenyl ethyl (DMNPE) group. This material was injected into the skin of streptozotocin-treated diabetic rats. We observed insulin being released into the bloodstream after a 2 min trans-cutaneous irradiation of this site by a compact LED light source. Control animals treated with the same material, but in which light was blocked from the site, showed no release of insulin into the bloodstream. We also demonstrate that additional pulses of light from the light source result in additional pulses of insulin being absorbed into circulation. A significant reduction in blood glucose was then observed. Together, these results demonstrate the feasibility of using light to allow for the continuously variable control of insulin release. This in turn has the potential to allow for the tight control of blood glucose without the invasiveness of insulin pumps and cannulas.

Quantitative assessment of dietary intake in adults with Type 1 diabetes following flexible insulin therapy education with an active promotion of dietary freedom

Clinical practice guidelines for diabetes include dietary guidelines to address the increased risk of cardiovascular disease.

AIMS

To identify impact of flexible insulin education with an active promotion of dietary freedom on energy and macronutrient intake and achievement of nutrient recommendations in adults with Type 1 diabetes.

METHODS

Dietary assessment was performed prior to and 12months following flexible insulin education. Nutrient intake and the proportion achieving the European Association for the Study of Diabetes (EASD) nutrient guidelines were compared at baseline and post course.

RESULTS

Dietary data were available for 46 participants. Post course reductions were seen in median [IQR] energy kcal/d (1799 [1521-1931] to 1592 [1378-1940], p=0.002), fibre g/1000kcal (14 [12-16] to 13 [11-15], p=0.047), protein g/day (89 ([78-108] to 82 [74-93], p=0.001) and carbohydrate g/day (198 [172-330] to 162 [143-204], p=<0.001). The proportion experiencing at least 1 severe hypoglycaemia event over 12months was significantly reduced (χ(2)=7.7, p=0.006) from baseline (n=13, 26%) to post course (n=3, 6%). Achievement of EASD guidelines was poor and did not change post course.

CONCLUSIONS

Flexible insulin education with an active promotion of dietary freedom does not appear to 'worsen' the achievement of EASD nutrition guidelines in adults with Type 1 diabetes. On the contrary, the dietary changes observed were reductions in energy, carbohydrate and protein intake. Flexible insulin education may offer benefits in enabling reduced energy intake without increasing hypoglycaemia.