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Abstract
The number of older adults with type 1 diabetes (T1D) is increasing due to an overall increase in life expectancy and improvement in diabetes management and treatment of complications. They are a heterogeneous cohort due to the dynamic process of aging and the presence of comorbidities and diabetes-related complications. A high risk for hypoglycemia unawareness and severe hypoglycemia has been described. Periodic assessment of health status and adjustment of glycemic goals to mitigate hypoglycemia is imperative. Continuous glucose monitoring, insulin pump, and hybrid closed-loop systems are promising tools to improve glycemic control and mitigate hypoglycemia in this age group.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center; Beth Israel Deaconess Medical Center; Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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Abe Y, Urakami T, Suzuki J, Morita S, Araki M, Mizota M, Sasaki G, Mori J, Tatematsu T, Mine Y, Yoshida K, Kikuchi T. Nighttime hypoglycemia in Japanese children with type 1 diabetes mellitus treated with multiple daily injection insulin therapy. Endocr J 2023. [PMID: 37019657 DOI: 10.1507/endocrj.ej22-0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Prevention of hypoglycemia is an important strategy for glycemic management in patients with type 1 diabetes mellitus (T1D). Hypoglycemia is difficult to recognize at night while sleeping, particularly when using multiple daily injection (MDI) insulin therapy rather than sensor-augmented insulin-pump therapy. Therefore, it is possible that patients with T1D are at higher risk of nocturnal hypoglycemia when insulin is administered using an MDI regimen. We investigated nocturnal hypoglycemia in 50 pediatric patients with T1D on MDI insulin therapy using data from an intermittently scanned continuous glucose monitoring (isCGM) system. Hypoglycemia was observed on 446 of the 1,270 nights studied. Most of the hypoglycemic episodes were severe (blood glucose <54 mg/dL). On nights when hypoglycemia occurred, the blood glucose concentrations measured using finger-stick blood glucose monitoring (FSGM) before sleep and the next morning were lower than nights when hypoglycemia did not occur. However, few values were below the normal blood glucose range, suggesting that FSGM alone may be insufficient to detect nocturnal hypoglycemia. Approximately 7% of time was spent below the normal glucose range during the 10 hours from 21:00 to 7:00 the next morning. This result suggests that the patients on MDI insulin therapy could end up spending more time in hypoglycemia than is recommended by the American Diabetes Association (time below range <4.0% of time per day). Monitoring glucose levels overnight using an isCGM sensor may improve glycemic management via automatic detection of blood glucose peaks and troughs.
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Affiliation(s)
- Yuki Abe
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Tatsuhiko Urakami
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Nihon University Hospital, Tokyo 101-8309, Japan
| | - Junichi Suzuki
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Nihon University Hospital, Tokyo 101-8309, Japan
| | - Satoshi Morita
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Kagoshima Seikyo Hospital, Kagoshima 891-0141, Japan
| | - Mariko Araki
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Kochi Medical School Hospital, Kochi 783-8505, Japan
| | - Michiyo Mizota
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Imamura General Hospital, Kagoshima 890-0064, Japan
| | - Goro Sasaki
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Tokyo Dental College, Ichikawa General Hospital, Chiba 272-8513, Japan
| | - Jun Mori
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Toshi Tatematsu
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Chubu Rosai Hospital, Aichi 455-8530, Japan
| | - Yusuke Mine
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Nihon University Hospital, Tokyo 101-8309, Japan
| | - Kei Yoshida
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Nihon University Hospital, Tokyo 101-8309, Japan
| | - Toru Kikuchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes, Kyoto 604-0835, Japan
- Department of Pediatrics, Saitama Medical University Hospital, Saitama 350-0495, Japan
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Silva IBB, Kimura CH, Colantoni VP, Sogayar MC. Stem cells differentiation into insulin-producing cells (IPCs): recent advances and current challenges. Stem Cell Res Ther 2022; 13:309. [PMID: 35840987 PMCID: PMC9284809 DOI: 10.1186/s13287-022-02977-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Type 1 diabetes mellitus (T1D) is a chronic disease characterized by an autoimmune destruction of insulin-producing β-pancreatic cells. Although many advances have been achieved in T1D treatment, current therapy strategies are often unable to maintain perfect control of glycemic levels. Several studies are searching for new and improved methodologies for expansion of β-cell cultures in vitro to increase the supply of these cells for pancreatic islets replacement therapy. A promising approach consists of differentiation of stem cells into insulin-producing cells (IPCs) in sufficient number and functional status to be transplanted. Differentiation protocols have been designed using consecutive cytokines or signaling modulator treatments, at specific dosages, to activate or inhibit the main signaling pathways that control the differentiation of induced pluripotent stem cells (iPSCs) into pancreatic β-cells. Here, we provide an overview of the current approaches and achievements in obtaining stem cell-derived β-cells and the numerous challenges, which still need to be overcome to achieve this goal. Clinical translation of stem cells-derived β-cells for efficient maintenance of long-term euglycemia remains a major issue. Therefore, research efforts have been directed to the final steps of in vitro differentiation, aiming at production of functional and mature β-cells and integration of interdisciplinary fields to generate efficient cell therapy strategies capable of reversing the clinical outcome of T1D.
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Affiliation(s)
- Isaura Beatriz Borges Silva
- Cell and Molecular Therapy Center (NUCEL), School of Medicine, University of São Paulo, São Paulo, SP, 05360-130, Brazil.,Department of Biochemistry, Chemistry Institute, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Camila Harumi Kimura
- Cell and Molecular Therapy Center (NUCEL), School of Medicine, University of São Paulo, São Paulo, SP, 05360-130, Brazil
| | - Vitor Prado Colantoni
- Cell and Molecular Therapy Center (NUCEL), School of Medicine, University of São Paulo, São Paulo, SP, 05360-130, Brazil.,Department of Biochemistry, Chemistry Institute, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Mari Cleide Sogayar
- Cell and Molecular Therapy Center (NUCEL), School of Medicine, University of São Paulo, São Paulo, SP, 05360-130, Brazil. .,Department of Biochemistry, Chemistry Institute, University of São Paulo, São Paulo, SP, 05508-000, Brazil.
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Katra B, Fedak D, Matejko B, Małecki MT, Wędrychowicz A. The enteroendocrine-osseous axis in patients with long-term type 1 diabetes mellitus. Bone 2021; 153:116105. [PMID: 34245933 DOI: 10.1016/j.bone.2021.116105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The relationship between the gut and skeleton is increasingly recognized as a component of the regulation of carbohydrate metabolism. The aim of our study was to assess the relationship between bone mineral density (BMD), incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), intestinotrophic peptide glucagon-like peptide-2 (GLP-2) and osteocalcin isoforms in patients with long-term type 1 diabetes (T1D) when compared to healthy controls. METHODS Eighty two patients with long term T1D, treated in the Department of Metabolic Diseases and 53 healthy controls were recruited to the study. Long term disease duration was defined as lasting for more than 10 years. The control group was selected among age- and sex-matched healthy people. Fasting blood samples were collected to measure levels of incretin hormones (GLP-1, GLP-2, GIP), two forms of osteocalcin (uncarboxylated (ucOC), and carboxylated (cOC)), and additional biochemical parameters associated with glucose and bone metabolism (HbA1c, calcium, phosphorus, 25(OH)D3, PTH). RESULTS Patients with T1D had higher BMI than in controls (p = 0.02). There was no difference in BMD at the lumbar spine and the femoral neck between patients with long-term T1D and healthy ones. Z-score values in both groups were within normal ranges. The level of GIP was significantly higher in T1D patients (p = 0.0002) in comparison to the healthy ones. The levels of GLP-1 and GLP-2 did not differ between T1D patients and controls. In the T1D group, strong, positive associations were found between serum levels of GLP-1 and cOC (r = 0.546, p < 0.001) and between GLP-1 and total OC (r = 0.51, p < 0.001), also after adjusting for BMI (p < 0.001 and p < 0.001, respectively). Significant positive associations were also found between serum levels of GLP-2 and cOC (r = 0.27, p = 0.013) and between GLP-2 and total OC (r = 0.25, p = 0.018), also in a multivariate regression (p = 0.009, p = 0,175, respectively). Moreover, in T1D patients, GLP-1 correlated positively with the femoral neck BMD (g/cm2) (r = 0.265, p = 0.016) and this association was statistically significant after adjusting for BMI (p = 0.011). These correlations were not present in the control group. The only significant correlation observed in the control group was between OC and BMD of the neck (p = 0.049 for neck BMD g/cm2, and p = 0.041 for neck Z-score). CONCLUSIONS Our data suggests an effect of gut hormones on bone in long-term T1D, which could be associated with OC activity, however we did not find a direct connection with glucose metabolism. GLP-1 could have a possible, protective role on bone mineral density in patients with T1D. The data from our study suggests that gut hormones could be considered as a new link in the skeleton - pancreatic endocrine loop in patients with T1D.
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Affiliation(s)
- Barbara Katra
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Fedak
- Department of Diagnostics, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Wędrychowicz
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland.
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Khdair SI, Jarrar W, Jarrar YB, Bataineh S, Al-Khaldi O. Association of HLA-DRB1 and -DQ Alleles and Haplotypes with Type 1 Diabetes in Jordanians. Endocr Metab Immune Disord Drug Targets 2021; 20:895-902. [PMID: 31742498 DOI: 10.2174/1871530319666191119114031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Human Leukocyte Antigen (HLA) class II genes, particularly the HLADR and -DQ loci, have been shown to play a crucial role in Type 1 Diabetes (T1D) development. OBJECTIVE This study is the first to examine the contribution of the HLA-DR/DQ alleles and haplotypes to T1D susceptibility in Jordanians. METHODS Polymerase chain reaction sequence-specific primers (PCR-SSP) were used to genotype 41 Jordanian healthy controls and 50 insulin-dependent diabetes mellitus (IDDM) patients. RESULTS The following alleles were found to be significant high risk alleles in T1D Jordanian patients: DRB1*04 (OR=3.95, p<0.001), DRB1*0301(OR=5.27, p<0.001), DQA1*0301 (OR=5.67, p<0.001), DQA1*0501(OR=3.18, p=0.002), DQB1*0201(OR=2.18, p=0.03), DQB1*0302 (OR=5.67, p<0.001). However, Jordanians harboring the DRB1*0701 (OR=0.37, p=0.01), DRB1*1101 (OR=0.2, p=0.01), DQA1*0505 (OR=0.31, p=0.02), DQA1*0103 (OR=0.33, p=0.04), DQA1*0201 (OR=0.45, p=0.04), DQB1*0301 (OR=0.23, p=0.001), DQB1*0501 (OR=0.18, p=0.009) alleles had a significantly lower risk of developing T1D. CONCLUSION A strong positive association of DRB1*04-DQA1*0301-DQBl*0302 (OR=5.67, p<0.001) and DRB1*0301-DQA1*0501-DQB1*0201 (OR=6.24, p<0.001) putative haplotypes with IDDM was evident in Jordanian IDDM patients whereas DRB1*1101-DQA1*0505- DQB1*0301 (OR=0.23, p=0.03) was shown to have a protective role against T1D in Jordanians. Our findings show that specific HLA class II alleles and haplotypes are significantly associated with susceptibility to T1D in Jordanians.
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Affiliation(s)
- Sawsan I Khdair
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan
| | - Wassan Jarrar
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan
| | - Yazun Bashir Jarrar
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan
| | - Safa'a Bataineh
- Diabetes Center, King Abdullah University Hospital, P.O.Box 630001, Irbid 21110, Jordan
| | - Omar Al-Khaldi
- Diabetes Center, King Abdullah University Hospital, P.O.Box 630001, Irbid 21110, Jordan
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Sorrenti V, Raffaele M, Vanella L, Acquaviva R, Salerno L, Pittalà V, Intagliata S, Di Giacomo C. Protective Effects of Caffeic Acid Phenethyl Ester (CAPE) and Novel Cape Analogue as Inducers of Heme Oxygenase-1 in Streptozotocin-Induced Type 1 Diabetic Rats. Int J Mol Sci 2019; 20:E2441. [PMID: 31108850 DOI: 10.3390/ijms20102441] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/16/2022] Open
Abstract
Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease resulting in the destruction of insulin producing β-cells of the pancreas, with consequent insulin deficiency and excessive glucose production. Hyperglycemia results in increased levels of reactive oxygen species (ROS) and nitrogen species (RNS) with consequent oxidative/nitrosative stress and tissue damage. Oxidative damage of the pancreatic tissue may contribute to endothelial dysfunction associated with diabetes. The aim of the present study was to investigate if the potentially protective effects of phenethyl ester of caffeic acid (CAPE), a natural phenolic compound occurring in a variety of plants and derived from honeybee hive propolis, and of a novel CAPE analogue, as heme oxygenase-1 (HO-1) inducers, could reduce pancreatic oxidative damage induced by excessive amount of glucose, affecting the nitric oxide synthase/dimethylarginine dimethylaminohydrolase (NOS/DDAH) pathway in streptozotocin-induced type 1 diabetic rats. Our data demonstrated that inducible nitric oxide synthase/gamma-Glutamyl-cysteine ligase (iNOS/GGCL) and DDAH dysregulation may play a key role in high glucose mediated oxidative stress, whereas HO-1 inducers such as CAPE or its more potent derivatives may be useful in diabetes and other stress-induced pathological conditions.
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