1
|
Downey L, O'Donnell S, Melvin T, Quigley M. A European regulatory pathway for Tidepool loop following clearance in the United States? Diabet Med 2024; 41:e15246. [PMID: 37873612 DOI: 10.1111/dme.15246] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
The recent clearance by the United States Food and Drug Administration of Tidepool Loop sets an important precedent within the medical device landscape. For the first time, an automated insulin delivery mobile application-based on an algorithm initially designed and developed by users -has been recognised as safe and effective by a regulatory body. The aim of this paper is twofold: firstly, we map out the regulatory pathways and processes that were navigated by Tidepool, the non-profit behind Tidepool Loop, in order to make this landmark moment possible. Secondly, we set out potential approvals processes in the European Union and United Kingdom with a view to examining the challenges to obtaining regulatory clearance for Tidepool Loop in these jurisdictions. In so doing, we highlight the significant differences, not only between the United States and European systems but also between the European Union and Great Britain systems. We conclude by arguing that the complexity encountered when seeking to introduce an innovative solution in different regulatory systems has the potential to act as a disincentive to open source developers from seeking regulatory approvals for such technologies in the future.
Collapse
Affiliation(s)
- Laura Downey
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Shane O'Donnell
- Birmingham Law School, University of Birmingham, Birmingham, UK
- College of Business, University College Dublin, Dublin, Ireland
| | - Tom Melvin
- School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | | |
Collapse
|
2
|
Ssemmondo E, Deshmukh H, Wilmot EG, Adeleke KA, Shah N, Walton C, Barnes D, Ryder REJ, Sathyapalan T. Effect of intermittently scanned continuous glucose monitoring in people with diabetes with a psychosocial indication for initiation. Diabetes Obes Metab 2024; 26:1340-1345. [PMID: 38228571 DOI: 10.1111/dom.15435] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
AIM To understand the effect of intermittently scanned continuous glucose monitoring (isCGM) in people with diabetes with a 'psychosocial' indication for access. METHODS The study utilized baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the UK. Diabetes-related distress (DRD) was assessed using the two-item diabetes-related distress scale (DDS). Participants were categorized into two groups: high DRD (DDS score ≥ 3) and lower DRD (DDS score < 3). The t-test was used to assess the difference in the pre- and post-isCGM continuous variables. RESULTS The study consisted of 17 036 people with diabetes, with 1314 (7%) using isCGM for 'psychosocial' reasons. Follow-up data were available for 327 participants, 322 (99%) of whom had type 1 diabetes with a median diabetes duration of 15 years; 75% (n = 241) had high levels of DRD. With the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in DDS score; 4 at baseline versus 2.5 at follow-up (P < .001). The prevalence of high DRD reduced from 76% to 38% at follow-up (50% reduction in DRD, P < .001). There was also a significant reduction in HbA1c (78.5 mmol/mol [9.3%] at baseline vs. 66.5 mmol/mol [8.2%] at follow-up; P < .001). This group also experienced an 87% reduction in hospital admissions because of hyperglycaemia/diabetic ketoacidosis (P < .001). CONCLUSION People with diabetes who had isCGM initiated for a psychosocial indication had high levels of DRD and HbA1c, which improved with the use of isCGM.
Collapse
Affiliation(s)
- Emmanuel Ssemmondo
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Harshal Deshmukh
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kazeem A Adeleke
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Najeeb Shah
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Thozhukat Sathyapalan
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| |
Collapse
|
3
|
Muntis FR, Crandell JL, Evenson KR, Maahs DM, Seid M, Shaikh SR, Smith-Ryan AE, Mayer-Davis E. Pre-exercise protein intake is associated with reduced time in hypoglycaemia among adolescents with type 1 diabetes. Diabetes Obes Metab 2024; 26:1366-1375. [PMID: 38221862 PMCID: PMC10922329 DOI: 10.1111/dom.15438] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
AIM Secondary analyses were conducted from a randomized trial of an adaptive behavioural intervention to assess the relationship between protein intake (g and g/kg) consumed within 4 h before moderate-to-vigorous physical activity (MVPA) bouts and glycaemia during and following MVPA bouts among adolescents with type 1 diabetes (T1D). MATERIALS AND METHODS Adolescents (n = 112) with T1D, 14.5 (13.8, 15.7) years of age and 36.6% overweight/obese, provided measures of glycaemia using continuous glucose monitoring [percentage of time above range (>180 mg/dl), time in range (70-180 mg/dl), time below range (TBR; <70 mg/dl)], self-reported physical activity (previous day physical activity recalls), and 24 h dietary recall data at baseline and 6 months post-intervention. Mixed effects regression models adjusted for design (randomization assignment, study site), demographic, clinical, anthropometric, dietary, physical activity and timing covariates estimated the association between pre-exercise protein intake on percentage of time above range, time in range and TBR during and following MVPA. RESULTS Pre-exercise protein intakes of 10-19.9 g and >20 g were associated with an absolute reduction of -4.41% (p = .04) and -4.83% (p = .02) TBR during physical activity compared with those who did not consume protein before MVPA. Similarly, relative protein intakes of 0.125-0.249 g/kg and ≥0.25 g/kg were associated with -5.38% (p = .01) and -4.32% (p = .03) absolute reductions in TBR during physical activity. We did not observe a significant association between protein intake and measures of glycaemia following bouts of MVPA. CONCLUSIONS Among adolescents with T1D, a dose of ≥10 g or ≥0.125 g/kg of protein within 4 h before MVPA may promote reduced time in hypoglycaemia during, but not following, physical activity.
Collapse
Affiliation(s)
- Franklin R Muntis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie L Crandell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Michael Seid
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
Harrington MP, Satherley RM, John M, O'Donnell N, Read R, Wakelin K, Jones CJ. Reliability and validity of a parent-reported screening tool for disordered eating in children and young people with type 1 diabetes. Diabet Med 2024; 41:e15256. [PMID: 37925592 DOI: 10.1111/dme.15256] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/08/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND There is a high prevalence and complex overlap between type 1 diabetes (T1D) and disordered eating. However, screening for disordered eating in children and young people (CYP) with T1D is not routinely conducted, with reluctance reported by both professionals and parents. This study aimed to validate a parent-reported version of a validated disordered eating screening tool for CYP with T1D (the Diabetes Eating Problems Survey-Revised; DEPS-R). METHODS The existing DEPS-R was adapted for parental use. Eighty-nine parents of CYP with T1D aged 11-14 years completed the parent-reported DEPS-R and other questionnaires related to demographics, child eating behaviours and parental well-being. CYP of parents were invited to participate, with 51 CYP completing the validated CYP-reported DEPS-R for comparison. RESULTS The parent-reported DEPS-R demonstrated good internal consistency (Cronbach's α = 0.89). Moderate to good inter-rater reliability was found between the parent-reported DEPS-R and CYP-reported DEPS-R (ICC 0.746, 95% CI = 0.554-0.855, p < 0.001), indicating good convergent validity. Construct validity with hypothesised variables, including specific eating behaviours, diabetes-related distress, well-being, CYP BMI, gender and parental worry about CYP disordered eating, suggested validity of the measure. However, some hypothesised variables did not significantly correlate with the parent-reported DEPS-R as expected. CONCLUSIONS The parent-reported DEPS-R has demonstrated good reliability and validity, and it may provide clinical benefit by increasing screening and early detection of disordered eating in CYP with T1D. Whilst novel and providing stepped increase in our knowledge, these findings would benefit from further validation (e.g. in a larger sample and responsiveness).
Collapse
Affiliation(s)
- Megan P Harrington
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| | - Rose-Marie Satherley
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| | - Mary John
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, UK
| | - Nicola O'Donnell
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| | - Rebecca Read
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| | - Katherine Wakelin
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| | - Christina J Jones
- School of Psychology, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| |
Collapse
|
5
|
Zaremba N, Harrison A, Brown J, Allan J, Pillay D, Treasure J, Ayis S, Hopkins D, Ismail K, Stadler M. Protocol for the STEADY intervention for type 1 diabetes and disordered eating: Safe management of people with Type 1 diabetes and EAting Disorders studY. Diabet Med 2024; 41:e15273. [PMID: 38191796 DOI: 10.1111/dme.15273] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
This paper describes the protocol to test the feasibility of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) intervention. STEADY is a novel complex intervention for people with type 1 diabetes and disordered eating (T1DE) of mild to moderate severity. The STEADY intervention integrates cognitive behavioural therapy (CBT) with diabetes education, and was developed using Experience-Based Co-Design. METHODS: The feasibility of STEADY will be tested using a randomised controlled feasibility trial. Forty adults with T1DE will be recruited and randomised into the STEADY intervention or treatment as usual control group. We will collect demographic, biomedical and psychometric data, routine glucose metrics and conduct the Structured Clinical Interview for DSM-5. Participants randomised to the STEADY intervention will receive 12 STEADY therapy sessions with a diabetes specialist nurse trained in CBT, delivered via videoconference and an optional smartphone app. The main outcome at 6 months will be the feasibility of STEADY (recruitment, dropout rates, feasibility of delivery). The secondary outcomes are biomedical (HbA1c and glucose time in range) and psychological (person-reported outcome measures in disordered eating, diabetes distress, depression and anxiety). A process evaluation will evaluate the fidelity, feasibility, acceptability and appropriateness of STEADY, and participant experiences. ETHICS AND DISSEMINATION: The protocol was approved by the East of England-Essex Research Ethics Committee (21/EE/0235). Study findings will be shared with study participants and disseminated through peer-reviewed publications and conference presentations.
Collapse
Affiliation(s)
- Natalie Zaremba
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Amy Harrison
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
- Department of Psychology and Human Development, Institute of Psychiatry, University College London, London, UK
| | - Jennie Brown
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Diabetes Centre, King's College Hospital, London, UK
| | - Jacqueline Allan
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Divina Pillay
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Salma Ayis
- School Population Health and Environmental Sciences, King's College London, London, UK
| | - David Hopkins
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
| | - Marietta Stadler
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
| |
Collapse
|
6
|
Qin WZ, Wang XF, Leng R, Xu WJ, Wang FF, Zhao W, Leng RX. Genetically predicted circulating interleukin-18 levels are associated with risk of systemic lupus erythematosus and type 1 diabetes. Lupus 2024; 33:403-408. [PMID: 38407846 DOI: 10.1177/09612033241235868] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Interleukin-18 (IL-18) is a proinflammatory cytokine. This study aims to determine whether there is a causal relationship between circulating IL-18 concentrations and the risk of inflammatory and autoimmune diseases. METHODS We collected significant single nucleotide polymorphisms (SNPs) associated with circulating IL-18 levels (p < 5 × 10-8) as instrumental variables (IVs) from a genome-wide association study (GWAS) involving 21,758 individuals of European descent. We mainly employed the inverse-variance weighed (IVW) method of two-sample Mendelian randomization (TSMR) analysis to estimate the causality of circulating IL-18 levels on inflammatory and autoimmune diseases. RESULTS The IVW method results showed evidence of a causal relationship between IL-18 and the risk of systemic lupus erythematosus (SLE) (OR = 1.32; 95% CI 1.15, 1.50; p < .001) and type 1 diabetes (T1D) (OR = 1.22; 95% CI 1.06, 1.42; p = .007) in individuals of European ancestry. No significant heterogeneity or horizontal pleiotropy for SLE and T1D was detected. The sensitivity analysis, which involved removing confounding SNP, produced similar results for SLE and T1D. The results of sensitivity analysis using leave-one-out method indicated no single SNP significantly influenced the analysis results. However, we did not find any significant findings for multiple sclerosis, psoriasis, asthma, and osteoarthritis. CONCLUSIONS Our analyses suggest that circulating IL-18 is significantly related to SLE and T1D and may serve as a potential target for the treatment of these diseases.
Collapse
Affiliation(s)
- Wei-Zi Qin
- Department of Prevention and Health Protection, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China
| | - Xu-Fan Wang
- Department of Infectious Disease Prevention and Control, Suzhou Industrial Park Center for Disease Control and Prevention, Suzhou, China
| | - Rui Leng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Wen-Jing Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Fei-Fei Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Wei Zhao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Rui-Xue Leng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| |
Collapse
|
7
|
Jones CJ, Read R, O'Donnell N, Wakelin K, John M, Skene SS, Stewart R, Hale L, Cooke D, Kanumakala S, Satherley RM. PRIORITY Trial: Results from a feasibility randomised controlled trial of a psychoeducational intervention for parents to prevent disordered eating in children and young people with type 1 diabetes. Diabet Med 2024; 41:e15263. [PMID: 38100228 DOI: 10.1111/dme.15263] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 03/16/2024]
Abstract
AIMS Children and young people (CYP) with type 1 diabetes (T1D) are at increased risk of disordered eating. This study aimed to determine the feasibility and acceptability of a novel, theoretically informed, two-session psychoeducational intervention for parents to prevent disordered eating in CYP with T1D. METHODS Parents of CYP aged 11-14 years with T1D were randomly allocated to the intervention or wait-list control group. Self-reported measures including the Diabetes Eating Problem Survey-Revised (DEPS-R), Problem Areas in Diabetes Parent Revised (PAID-PR), Child Eating Behaviour Questionnaire subscales (CEBQ), Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), clinical outcomes (e.g. HbA1c, BMI, medication and healthcare utilisation) and process variables, were collected at baseline, 1-and 3-month assessments. Acceptability data were collected from intervention participants via questionnaire. RESULTS Eighty-nine parents were recruited, which exceeded recruitment targets, with high intervention engagement and acceptability (<80% across domains). A signal of efficacy was observed across outcome measures with moderate improvements in the CEBQ subscale satiety responsiveness (d = 0.55, 95% CI 0.01, 1.08) and child's BMI (d = -0.56, 95% CI -1.09, 0.00) at 3 months compared with controls. Trends in the anticipated direction were also observed with reductions in disordered eating (DEPS-R) and diabetes distress (PAID-PR) and improvements in wellbeing (WEMWBS). CONCLUSIONS This is the first study to have co-designed and evaluated a novel parenting intervention to prevent disordered eating in CYP with T1D. The intervention proved feasible and acceptable with encouraging effects. Preparatory work is required prior to definitive trial to ensure the most relevant primary outcome measure and ensure strategies for optimum outcome completion.
Collapse
Affiliation(s)
- Christina J Jones
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Rebecca Read
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Nicola O'Donnell
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Katherine Wakelin
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Mary John
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
- Sussex Partnership NHS Foundation Trust, Research and Development Department, Sussex Education Centre, Hove, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Rose Stewart
- Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Lucy Hale
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Debbie Cooke
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Shankar Kanumakala
- Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Rose-Marie Satherley
- School of Psychology, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| |
Collapse
|
8
|
Kubilay E, Trawley S, Ward GM, Fourlanos S, Colman PG, McAuley SA. Real-world lived experience of older adults with type 1 diabetes after an automated insulin delivery trial. Diabet Med 2024; 41:e15264. [PMID: 38073128 DOI: 10.1111/dme.15264] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/20/2023] [Indexed: 03/16/2024]
Abstract
AIMS First-generation closed-loop automated insulin delivery improves glycaemia and psychosocial outcomes among older adults with type 1 diabetes in clinical trials. However, no study has previously assessed real-world lived experience of older adults using closed-loop therapy outside a trial environment. METHODS Semi-structured interviews were conducted with older adults who were pre-existing insulin pump users and previously completed the OldeR Adult Closed-Loop (ORACL) randomised trial. Interviews focused on perceptions of diabetes technology use, and factors influencing decisions regarding continuation. RESULTS Twenty-eight participants, mean age 70 years (SD 5), were interviewed at median 650 days (IQR 608-694) after their final ORACL trial visit. At interview, 23 participants (82%) were still using a commercial closed-loop system (requiring manual input for prandial insulin bolus doses). Themes discussed in interviews relating to closed-loop system use included sustained psychosocial benefits, cost and retirement considerations and usability frustrations relating to sensor accuracy and system alarms. Of the five participants who had discontinued, reasons included cost, continuous glucose monitoring-associated difficulties and usability frustrations. Cost was the largest consideration regarding continued use; most participants considered the increased ease of diabetes management to be worth the associated costs, though cost was prohibitive for some. CONCLUSIONS Almost 2 years after completing a closed-loop clinical trial, closed-loop automated insulin delivery remains the preferred type 1 diabetes therapy for the majority of older adult participants. Chronological age is not a barrier to real-world successful use of diabetes technology. Identifying age-related barriers, and solutions, to diabetes technology use among older adults is warranted.
Collapse
Affiliation(s)
- Erin Kubilay
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steven Trawley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sybil A McAuley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
McKechnie V, Broomhead A, Scior K, Roe D, Oliver N. Stigma experiences of adults living with diabetes: Results from a Diabetes UK survey. Diabet Med 2024; 41:e15289. [PMID: 38239184 DOI: 10.1111/dme.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/09/2024] [Indexed: 03/16/2024]
Affiliation(s)
- Vicky McKechnie
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| |
Collapse
|
10
|
Deshmukh H, Adeleke K, Wilmot EG, Folwell A, Barnes D, Walker N, Saunders S, Ssemmondo E, Walton C, Patmore J, Ryder REJ, Sathyapalan T. Clinical features of type 1 diabetes in older adults and the impact of intermittently scanned continuous glucose monitoring: An Association of British Clinical Diabetologists (ABCD) study. Diabetes Obes Metab 2024; 26:1333-1339. [PMID: 38164758 DOI: 10.1111/dom.15434] [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: 11/04/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
AIMS To evaluate the clinical features and impact of flash glucose monitoring in older adults with type 1 diabetes (T1D) across age groups defined as young-old, middle-old, and old-old. MATERIALS AND METHODS Clinicians were invited to submit anonymized intermittently scanned continuous glucose monitoring (isCGM) user data to a secure web-based tool within the National Health Service secure network. We collected baseline data before isCGM initiation, such as demographics, glycated haemoglobin (HbA1c) values from the previous 12 months, Gold scores and Diabetes Distress Scale (DDS2) scores. For analysis, people with diabetes were classified as young-old (65-75 years), middle-old (>75-85 years) and old-old (>85 years). We compared baseline clinical characteristics across the age categories using a t test. All the analyses were performed in R 4.1.2. RESULTS The study involved 1171 people with diabetes in the young-old group, 374 in the middle-old group, and 47 in the old-old group. There were no significant differences in baseline HbA1c and DDS2 scores among the young-old, middle-old, and old-old age groups. However, Gold score increased with age (3.20 [±1.91] in the young-old vs. 3.46 [±1.94] in the middle-old vs. 4.05 [±2.28] in the old-old group; p < 0.0001). This study showed reduced uptake of insulin pumps (p = 0.005) and structured education (Dose Adjustment For Normal Eating [DAFNE] course; p = 0.007) in the middle-old and old-old populations compared to the young-old population with T1D. With median isCGM use of 7 months, there was a significant improvement in HbA1c in the young-old (p < 0.001) and old-old groups, but not in the middle-old group. Diabetes-related distress score (measured by the DDS2) improved in all three age groups (p < 0.001) and Gold score improved (p < 0.001) in the young-old and old-old populations but not in the middle-old population. There was also a significant improvement in resource utilization across the three age categories following the use of is CGM. CONCLUSION This study demonstrated significant differences in hypoglycaemia awareness and insulin pump use across the older age groups of adults with T1D. The implementation of isCGM demonstrated significant improvements in HbA1c, diabetes-related distress, hypoglycaemia unawareness, and resource utilization in older adults with T1D.
Collapse
Affiliation(s)
- Harshal Deshmukh
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Kazeem Adeleke
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Anna Folwell
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Neil Walker
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Simon Saunders
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Rainhill, UK
| | - Emmanuel Ssemmondo
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Jane Patmore
- Allam Diabetes Centre, University of Hull, Hull, UK
| | | | - Thozhukat Sathyapalan
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| |
Collapse
|
11
|
Lei M, Ling P, Ni Y, Chen D, Wang C, Yang D, Yang X, Xu W, Yan J. The efficacy of glucose-responsive insulin and glucagon delivery on exercise-induced hypoglycaemia among adults with type 1 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Obes Metab 2024; 26:1524-1528. [PMID: 38149727 DOI: 10.1111/dom.15422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Mengyun Lei
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Ling
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Ni
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Danrui Chen
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chaofan Wang
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Daizhi Yang
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xubin Yang
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen Xu
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinhua Yan
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
12
|
Li SJ, Wu YL, Chen JH, Shen SY, Duan J, Xu HE. Autoimmune diseases: targets, biology, and drug discovery. Acta Pharmacol Sin 2024; 45:674-685. [PMID: 38097717 PMCID: PMC10943205 DOI: 10.1038/s41401-023-01207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/20/2023] [Indexed: 03/17/2024] Open
Abstract
Autoimmune diseases (AIDs) arise from a breakdown in immunological self-tolerance, wherein the adaptive immune system mistakenly attacks healthy cells, tissues and organs. AIDs impose excessive treatment costs and currently rely on non-specific and universal immunosuppression, which only offer symptomatic relief without addressing the underlying causes. AIDs are driven by autoantigens, targeting the autoantigens holds great promise in transforming the treatment of these diseases. To achieve this goal, a comprehensive understanding of the pathogenic mechanisms underlying different AIDs and the identification of specific autoantigens are critical. In this review, we categorize AIDs based on their underlying causes and compile information on autoantigens implicated in each disease, providing a roadmap for the development of novel immunotherapy regimens. We will focus on type 1 diabetes (T1D), which is an autoimmune disease characterized by irreversible destruction of insulin-producing β cells in the Langerhans islets of the pancreas. We will discuss insulin as possible autoantigen of T1D and its role in T1D pathogenesis. Finally, we will review current treatments of TID and propose a potentially effective immunotherapy targeting autoantigens.
Collapse
Affiliation(s)
- Shu-Jie Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- Department of Traditional Chinese Medicine, Fujian Medical University Union Hospital, Fuzhou, 350000, China.
| | - Yan-Li Wu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Juan-Hua Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Shi-Yi Shen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jia Duan
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan, 528400, China.
| | - H Eric Xu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- School of Life Science and Technology, Shanghai Tech University, Shanghai, 201210, China.
| |
Collapse
|
13
|
Marigliano M, Piona C, Mancioppi V, Morotti E, Morandi A, Maffeis C. Glucose sensor with predictive alarm for hypoglycaemia: Improved glycaemic control in adolescents with type 1 diabetes. Diabetes Obes Metab 2024; 26:1314-1320. [PMID: 38177091 DOI: 10.1111/dom.15432] [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: 11/01/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
AIM Hypoglycaemic events are linked to microvascular and macrovascular complications in people with type 1 diabetes. We aimed to evaluate the efficacy of glucose sensor [real-time continuous glucose monitoring (RT-CGM)] with predictive alarm (PA) in reducing the time spent below the range (%TBR <70 mg/dl) in a group of adolescents with type 1 diabetes (AwD). MATERIALS AND METHODS This was a crossover, monocentric and randomized study. RT-CGM was set with Alarm on Threshold (AoT) at 70 mg/dl) or PA for hypoglycaemia (20 m before threshold). Twenty AwD were enrolled and randomized to either a PA/AoT or AoT/PA treatment sequence, in a 1:1 ratio. The two groups (PA vs. AoT) were compared using two-way repeated measures ANOVA taking account of the carryover effect. RESULTS AwD using PA for hypoglycaemia spent less time in severe hypoglycaemia (%TBR2 <54 mg/dl; 0.32 ± 0.31 vs. 0.91 ± 0.90; p < .02) and hypoglycaemia (%TBR <70 mg/dl; 1.68 ± 1.06 vs. 2.90 ± 2.05; p < .02), with better glycaemia risk index (51.3 ± 11.0 vs. 61.5 ± 12.6; p ≤ .01). CONCLUSION The use of RT-CGM with PA for hypoglycaemia technology in AwD using multiple daily insulin injection treatment could significantly reduce the risk of having hypoglycaemic events resulting in an improved quality of glucose control. CLINICAL TRIAL REGISTRATION NUMBER NCT05574023.
Collapse
Affiliation(s)
- Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Valentina Mancioppi
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Elisa Morotti
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| |
Collapse
|
14
|
Ehrmann D, Hermanns N, Finke-Gröne K, Roos T, Kober J, Schäfer V, Krichbaum M, Haak T, Ziegler R, Heinemann L, Rieger C, Bingol E, Kulzer B, Silbermann S. Efficacy of a Digital Diabetes Logbook for People With Type 1, Type 2, and Gestational Diabetes: Results From a Multicenter, Open-Label, Parallel-Group, Randomized Controlled Trial. J Diabetes Sci Technol 2024:19322968241239870. [PMID: 38529954 DOI: 10.1177/19322968241239870] [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: 03/27/2024]
Abstract
BACKGROUND In a randomized controlled trial, the efficacy of a digital diabetes diary regarding a reduction of diabetes distress was evaluated. METHODS A randomized controlled trial with a 12-week follow-up was conducted in 41 study sites across Germany. Key eligibility criteria were a diagnosis of type 1, type 2, or gestational diabetes and regular self-monitoring of blood glucose. Participants were randomly assigned (2:1 ratio) to either use the digital diabetes logbook (mySugr PRO), or to the control group without app use. The primary outcome was the reduction in diabetes distress at the 12-week follow-up. All analyses were based on the intention-to-treat population with all randomized participants. The trial was registered at the German Register for Clinical Studies (DRKS00022923). RESULTS Between February 11, 2021, and June 24, 2022, 424 participants (50% female, 50% male) were included, with 282 being randomized to the intervention group (66.5%) and 142 to the control group (33.5%). A total of 397 participants completed the trial (drop-out rate: 6.4%). The median reduction in diabetes distress was 2.41 (interquartile range [IQR]: -2.50 to 8.11) in the intervention group and 1.25 (IQR: -5.00 to 7.50) in the control group. The model-based adjusted between-group difference was significant (-2.20, IQR: -4.02 to -0.38, P = .0182) favoring the intervention group. There were 27 adverse events, 17 (6.0%) in the intervention group, and 10 (7.0%) in the control group. CONCLUSIONS The efficacy of the digital diabetes logbook was demonstrated regarding improvements in mental health in people with type 1, type 2, and gestational diabetes.
Collapse
Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Katharina Finke-Gröne
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Timm Roos
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | | | | | - Michael Krichbaum
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Thomas Haak
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | | | | | | | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | | |
Collapse
|
15
|
Lin C, Hu S, Cai X, Lv F, Yang W, Liu G, Yang X, Ji L. The opportunities and challenges of the disease-modifying immunotherapy for type 1 diabetes: a systematic review and meta-analysis. Pharmacol Res 2024; 203:107157. [PMID: 38531504 DOI: 10.1016/j.phrs.2024.107157] [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] [Received: 12/17/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
There are multiple disease-modifying immunotherapies showing the potential of preventing or delaying the progression of type 1 diabetes (T1D). We designed and performed this systematic review and meta-analysis to gain an overview of what a role immunotherapy plays in the treatment of T1D. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to December 2023. We included clinical trials of immunotherapy conducted in patients with T1D that reported the incidence of hypoglycemia or changes from baseline in at least one of following outcomes: 2h and 4h mixed-meal-stimulated C-peptide area under the curve (AUC), fasting C-peptide, daily insulin dosage, glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG). The results were computed as the weighted mean differences (WMDs) or odds ratios (ORs) and 95% confidence intervals (CIs) in random-effect model. In all, 34 clinical trials were included. When compared with control groups, 2h C-peptide AUC was marginally higher in patient treated with nonantigen-based immunotherapies (WMD, 0.04nmol/L, 95% CI, 0.00 to 0.09nmol/L, P=0.05), which was mainly driven by the effects of T cell-targeted therapy. A greater preservation in 4h C-peptide AUC was observed in patients with nonantigen-based immunotherapies (WMD, 0.10nmol/L, 95% CI, 0.04 to 0.16nmol/L, P=0.0007), which was mainly driven by the effects of tumor necrosis factor α (TNF-α) inhibitor and T cell-targeted therapy. After excluding small-sample trials, less daily insulin dosage was observed in patient treated with nonantigen-based immunotherapies when compared with control groups (WMD, -0.07units/kg/day, 95% CI, -0.11 to -0.03units/kg/day, P=0.0004). The use of antigen-based immunotherapies was also associated with a lower daily insulin dosage versus control groups (WMD, -0.11units/kg/day, 95% CI, -0.23 to -0.00units/kg/day, P=0.05). However, changes of HbA1c or FBG were comparable between nonantigen-based immunotherapies or antigen-based immunotherapies and control groups. The risk of hypoglycemia was not increased in patients treated with nonantigen-based immunotherapies or patients treated with antigen-based immunotherapies when compared with control groups. In conclusion, nonantigen-based immunotherapies were associated with a preservation of 2h and 4h C-peptide AUC in patients with T1D when compared with the controls, which was mainly driven by the effects of TNF-a inhibitor and T cell-targeted therapy. Both nonantigen-based immunotherapies and antigen-based immunotherapies tended to reduce the daily insulin dosage in patients with T1D when compared with the controls. However, they did not contribute to a substantial improvement in HbA1c or FBG. Both nonantigen-based immunotherapies and antigen-based immunotherapies were well tolerated with not increased risk of hypoglycemia in patients with T1D.
Collapse
Affiliation(s)
- Chu Lin
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Suiyuan Hu
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Fang Lv
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Geling Liu
- Department of Endocrinology (Section I), Tangshan Gongren Hospital, Tangshan, Hebei, China.
| | - Xiaolin Yang
- Department of Endocrinology (Section I), Tangshan Gongren Hospital, Tangshan, Hebei, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| |
Collapse
|
16
|
Li JH, Zhang M, Zhang ZD, Pan XH, Pan LL, Sun J. GPR41 deficiency aggravates type 1 diabetes in streptozotocin-treated mice by promoting dendritic cell maturation. Acta Pharmacol Sin 2024:10.1038/s41401-024-01242-7. [PMID: 38514862 DOI: 10.1038/s41401-024-01242-7] [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] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
Disturbances in intestinal immune homeostasis predispose susceptible individuals to type 1 diabetes (T1D). G-protein-coupled receptor 41 (GPR41) is a receptor for short-chain fatty acids (SCFAs) mainly produced by gut microbiota, which plays key roles in maintaining intestinal homeostasis. In this study, we investigated the role of GPR41 in the progression of T1D. In non-obese diabetic (NOD) mice, we found that aberrant reduction of GPR41 expression in the pancreas and colons was associated with the development of T1D. GPR41-deficient (Gpr41-/-) mice displayed significantly exacerbated streptozotocin (STZ)-induced T1D compared to wild-type mice. Furthermore, Gpr41-/- mice showed enhanced gut immune dysregulation and increased migration of gut-primed IFN-γ+ T cells to the pancreas. In bone marrow-derived dendritic cells from Gpr41-/- mice, the expression of suppressor of cytokine signaling 3 (SOCS) was significantly inhibited, while the phosphorylation of STAT3 was significantly increased, thus promoting dendritic cell (DC) maturation. Furthermore, adoptive transfer of bone marrow-derived dendritic cells (BMDC) from Gpr41-/- mice accelerated T1D in irradiated NOD mice. We conclude that GPR41 is essential for maintaining intestinal and pancreatic immune homeostasis and acts as a negative regulator of DC maturation in T1D. GPR41 may be a potential therapeutic target for T1D.
Collapse
Affiliation(s)
- Jia-Hong Li
- Department of Pediatric Laboratory, Affiliated Children's Hospital of Jiangnan University (Wuxi Children's Hospital), Jiangnan University, Wuxi, 214023, China
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, China
| | - Ming Zhang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Zhao-di Zhang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Xiao-Hua Pan
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Li-Long Pan
- Department of Pediatric Laboratory, Affiliated Children's Hospital of Jiangnan University (Wuxi Children's Hospital), Jiangnan University, Wuxi, 214023, China.
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, China.
| | - Jia Sun
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, 214122, China.
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, China.
| |
Collapse
|
17
|
Pulkkinen MA, Varimo TJ, Hakonen ET, Hero MT, Miettinen PJ, Tuomaala AK. During an 18-month course of automated insulin delivery treatment, children aged 2 to 6 years achieve and maintain a higher time in tight range. Diabetes Obes Metab 2024. [PMID: 38514384 DOI: 10.1111/dom.15562] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
AIMS To investigate whether the positive effects on glycaemic outcomes of 3-month automated insulin delivery (AID) achieved in 2- to 6-year-old children endure over an extended duration and how AID treatment affects time in tight range (TITR), defined as 3.9-7.8 mmol/L. RESEARCH DESIGN AND METHODS We analysed 18 months of follow-up data from a non-randomized, prospective, single-arm clinical trial (n = 35) conducted between 2021 and 2023. The main outcome measures were changes in time in range (TIR), glycated haemoglobin (HbA1c), time above range (TAR), TITR, and mean sensor glucose (SG) value during follow-up visits (at 0, 6, 12 and 18 months). The MiniMed 780G AID system in SmartGuard Mode was used for 18 months. Parental diabetes distress was evaluated at 3 and 18 months with the validated Problem Areas in Diabetes-Parent, revised (PAID-PR) survey. RESULTS Between 0 and 6 months, TIR and TITR increased, and HbA1c, mean SG value and TAR decreased significantly (p < 0.001); the favourable effect persisted through 18 months of follow-up. Between 3 and 18 months, PAID-PR score declined significantly (0 months: mean score 37.5; 3 months: mean score 28.6 [p = 0.06]; 18 months: mean score 24.6 [p < 0.001]). CONCLUSIONS Treatment with AID significantly increased TITR and TIR in young children. The positive effect of AID on glycaemic control observed after 6 months persisted throughout the 18 months of follow-up. Similarly, parental diabetes distress remained reduced during 18 months follow-up. These findings are reassuring and suggest that AID treatment improves glycaemic control and reduces parental diabetes distress in young children over an extended 18-month follow-up.
Collapse
Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero J Varimo
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elina T Hakonen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti T Hero
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, Paediatric Research Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
18
|
Gómez Medina AM, Parra Prieto DA, Henao Carrillo DC, Gómez CM, Muñoz Velandia OM, Caicedo S, Kerguelen Villadiego AL, Rodríguez Hortúa LM, Lucero Pantoja OD, Uribe Valencia M, García Guete MM, Robledo Gómez S, Rondón Sepúlveda M. Characteristics Associated With Elevated Time Below Range in Elderly Patients With Type 1 Diabetes Using an Automated Insulin Delivery System. J Diabetes Sci Technol 2024:19322968241232659. [PMID: 38506435 DOI: 10.1177/19322968241232659] [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: 03/21/2024]
Abstract
BACKGROUND This study investigated the characteristics associated with an increased risk of hypoglycemia, in elderly patients with type 1 diabetes mellitus (T1D) using automated insulin delivery (AID) systems. METHODS Cross-sectional observational study including patients >60 years, using sensor-augmented insulin pump therapy with predictive low-glucose management (SAPT-PLGM), hybrid closed-loop (HCL), and advanced hybrid closed-loop (AHCL), for more than three months. A geriatric assessment was performed, and body composition was determined to investigate its association with achieving time below range (TBR) <70 mg/dL goals. RESULTS The study included 59 patients (47.5% of men, mean age of 67.6 years, glycated hemoglobin [HbA1c] of 7.5 ± 0.6%, time in range (TIR) 77.8 ± 9.9%). Time below range <70 and <54 mg/dL were 2.2 ± 2.3% and 0.4 ± 0.81%, respectively. Patients with elevated TBR <70 mg/dL (>1%) had higher HbA1c levels, lower TIR, elevated time above range (TAR), and high glycemic variability. Regarding body composition, greater muscle mass, grip strength, and visceral fat were associated with a lower TBR <70 mg/dL. These factors were independent of the type of technology used, but TIR was higher when using AHCL systems compared with SAPT-PLGM and HCL systems. CONCLUSIONS In elderly patients treated with AID systems with good functional status, lower lean mass, lower grip strength, and lower visceral fat percentage were associated with TBR greater than 1%, regardless of the device used. A similar finding along was found with CGM indicators such as higher HbA1c levels, lower TIR, higher TAR, and higher CV. Geriatric assessment is crucial for personalizing patient management.
Collapse
Affiliation(s)
- Ana María Gómez Medina
- Hospital Universitario San Ignacio and Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Darío A Parra Prieto
- Hospital Universitario San Ignacio and Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | | | | | - Sandra Caicedo
- Hospital Universitario San Ignacio and Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Tayyem R, Nawaiseh H, Zakarneh SB, Khial Y, Allehdan S. Assessment of Nutrients Intake in Pediatrics with Type 1 Diabetes and Dyslipidemia in Jordan. Adolesc Health Med Ther 2024; 15:31-43. [PMID: 38529360 PMCID: PMC10961238 DOI: 10.2147/ahmt.s439046] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/04/2024] [Indexed: 03/27/2024] Open
Abstract
Background Dyslipidemias are disorders of lipoprotein metabolism that occur during childhood and adolescence, often persist into adulthood, and increase the risk of developing atherosclerotic lesions. This study aimed to assess the potential association between nutrient intake and dyslipidemia in Jordanian pediatric patients diagnosed with type 1 diabetes mellitus. Methods This cross-sectional study was conducted in Amman, Jordan, and involved 90 children and adolescents diagnosed with type 1 diabetes mellitus. Caregivers provided the following data: sex, age, type and dose of insulin, age at onset of type 1 diabetes, and level of physical activity. Anthropometric measurements were obtained using calibrated scales, and CDC growth charts were used to assess participants' body weight status. Nutrient intake was estimated using a 120-item food frequency questionnaire (FFQ) previously validated in Jordanian children and adolescents. Serum lipid levels, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were measured. Binary logistic regression was used to assess the relationship between nutrient intake and dyslipidemia. Results The results indicated that 36.7% of study participants had dyslipidemia. There were no significant differences in nutrient intake between dyslipidemic and normolipidemic individuals, except for a significantly higher median intake of vitamin B12 in the dyslipidemic group compared to the normolipidemic group (3.6 versus 2.7 µg, P-value = 0.046). Conclusion This study found no significant association between the prevalence of dyslipidemia and nutrient intake in children and adolescents diagnosed with type 1 diabetes mellitus.
Collapse
Affiliation(s)
- Reema Tayyem
- Department of Human Nutrition, College of Health Science, Qatar University, Doha, Qatar
| | - Hala Nawaiseh
- Department of Nutrition & Food Technology, Faculty of Agriculture, The University of Jordan, Amman, 11942, Jordan
| | - Sara Basem Zakarneh
- Department of Nutrition & Food Technology, Faculty of Agriculture, The University of Jordan, Amman, 11942, Jordan
| | - Yasmen Khial
- Department of Human Nutrition, College of Health Science, Qatar University, Doha, Qatar
| | - Sabika Allehdan
- Department of Biology, College of Science, University of Bahrain, Zallaq, Kingdom of Bahrain
| |
Collapse
|
20
|
Hawks ZW, Beck ED, Jung L, Fonseca LM, Sliwinski MJ, Weinstock RS, Grinspoon E, Xu I, Strong RW, Singh S, Van Dongen HPA, Frumkin MR, Bulger J, Cleveland MJ, Janess K, Kudva YC, Pratley R, Rickels MR, Rizvi SR, Chaytor NS, Germine LT. Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes. NPJ Digit Med 2024; 7:59. [PMID: 38499605 PMCID: PMC10948782 DOI: 10.1038/s41746-024-01036-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.
Collapse
Affiliation(s)
- Z W Hawks
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - E D Beck
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - L Jung
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - L M Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - M J Sliwinski
- Department of Human Development and Family Studies, Center for Healthy Aging, Pennsylvania State University, State College, PA, USA
| | | | - E Grinspoon
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - I Xu
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - R W Strong
- The Many Brains Project, Belmont, MA, USA
| | - S Singh
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - H P A Van Dongen
- Sleep and Performance Research Center & Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - M R Frumkin
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - J Bulger
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - M J Cleveland
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - K Janess
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Y C Kudva
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - R Pratley
- AdventHealth Translational Research Institute, Orlando, FL, USA
| | - M R Rickels
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S R Rizvi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - N S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - L T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Bornstein SR, de Zeeuw D, Heerspink HJL, Schulze F, Cronin L, Wenz A, Tuttle KR, Hadjadj S, Rossing P. Aldosterone synthase inhibitor (BI 690517) therapy for people with diabetes and albuminuric chronic kidney disease: A multicentre, randomized, double-blind, placebo-controlled, Phase I trial. Diabetes Obes Metab 2024. [PMID: 38497241 DOI: 10.1111/dom.15518] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 03/19/2024]
Abstract
AIM This Phase I study evaluated the safety and early efficacy of an aldosterone synthase inhibitor (BI 690517) in people with diabetes and albuminuric chronic kidney disease. METHODS Double-blind, placebo-controlled study (NCT03165240) at 40 sites across Europe. Eligible participants [estimated glomerular filtration rate ≥20 and <75 ml/min/1.73 m2 ; urine albumin/creatinine ratio (UACR) ≥200 and <3500 mg/g] were randomized 6:1 to receive once-daily oral BI 690517 3, 10 or 40 mg, or eplerenone 25-50 mg, or placebo, for 28 days. The primary endpoint was the proportion of participants with drug-related adverse events (AEs). Secondary endpoints included changes from baseline in the UACR. RESULTS Fifty-eight participants were randomized and treated from 27 November 2017 to 16 April 2020 (BI 690517: 3 mg, n = 18; 10 mg, n = 13; 40 mg, n = 14; eplerenone, n = 4; placebo, n = 9) for 28 days. Eight (13.8%) participants experienced drug-related AEs [BI 690517: 3 mg (two of 18); 10 mg (four of 13); 40 mg (two of 14)], most frequently constipation [10 mg (one of 13); 40 mg (one of 14)] and hyperkalaemia [3 mg (one of 18); 10 mg (one of 13)]. Most AEs were mild to moderate; one participant experienced severe hyperkalaemia (serum potassium 6.9 mmol/L; BI 690517 10 mg). UACR responses [≥20% decrease from baseline (first morning void urine) after 28 days] were observed for 80.0% receiving BI 690517 40 mg (eight of 10) versus 37.5% receiving placebo (three of eight). Aldosterone levels were suppressed by BI 690517, but not eplerenone or placebo. CONCLUSIONS BI 690517 was generally well tolerated, reduced plasma aldosterone and may decrease albuminuria in participants with diabetes and albuminuric chronic kidney disease.
Collapse
Affiliation(s)
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Friedrich Schulze
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Lisa Cronin
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Arne Wenz
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Katherine R Tuttle
- Providence Health Care, University of Washington, Spokane, Washington, USA
| | - Samy Hadjadj
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| |
Collapse
|
22
|
Fox DS, Ware J, Boughton CK, Allen JM, Wilinska ME, Tauschmann M, Denvir L, Thankamony A, Campbell F, Wadwa RP, Buckingham BA, Davis N, DiMeglio LA, Mauras N, Besser REJ, Ghatak A, Weinzimer SA, Kanapka L, Kollman C, Sibayan J, Beck RW, Hood KK, Hovorka R. Cost-Effectiveness of Closed-Loop Automated Insulin Delivery Using the Cambridge Hybrid Algorithm in Children and Adolescents with Type 1 Diabetes: Results from a Multicenter 6-Month Randomized Trial. J Diabetes Sci Technol 2024:19322968241231950. [PMID: 38494876 DOI: 10.1177/19322968241231950] [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: 03/19/2024]
Abstract
BACKGROUND/OBJECTIVE The main objective of this study is to evaluate the incremental cost-effectiveness (ICER) of the Cambridge hybrid closed-loop automated insulin delivery (AID) algorithm versus usual care for children and adolescents with type 1 diabetes (T1D). METHODS This multicenter, binational, parallel-controlled trial randomized 133 insulin pump using participants aged 6 to 18 years to either AID (n = 65) or usual care (n = 68) for 6 months. Both within-trial and lifetime cost-effectiveness were analyzed. Analysis focused on the treatment subgroup (n = 21) who received the much more reliable CamAPS FX hardware iteration and their contemporaneous control group (n = 24). Lifetime complications and costs were simulated via an updated Sheffield T1D policy model. RESULTS Within-trial, both groups had indistinguishable and statistically unchanged health-related quality of life, and statistically similar hypoglycemia, severe hypoglycemia, and diabetic ketoacidosis (DKA) event rates. Total health care utilization was higher in the treatment group. Both the overall treatment group and CamAPS FX subgroup exhibited improved HbA1C (-0.32%, 95% CI: -0.59 to -0.04; P = .02, and -1.05%, 95% CI: -1.43 to -0.67; P < .001, respectively). Modeling projected increased expected lifespan of 5.36 years and discounted quality-adjusted life years (QALYs) of 1.16 (U.K. tariffs) and 1.52 (U.S. tariffs) in the CamAPS FX subgroup. Estimated ICERs for the subgroup were £19 324/QALY (United Kingdom) and -$3917/QALY (United States). For subgroup patients already using continuous glucose monitors (CGM), ICERs were £10 096/QALY (United Kingdom) and -$33 616/QALY (United States). Probabilistic sensitivity analysis generated mean ICERs of £19 342/QALY (95% CI: £15 903/QALY to £22 929/QALY) (United Kingdom) and -$28 283/QALY (95% CI: -$59 607/QALY to $1858/QALY) (United States). CONCLUSIONS For children and adolescents with T1D on insulin pump therapy, AID using the Cambridge algorithm appears cost-effective below a £20 000/QALY threshold (United Kingdom) and cost saving (United States).
Collapse
Affiliation(s)
- D Steven Fox
- Department of Pharmaceutical and Health Economics, Mann School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Julia Ware
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Charlotte K Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Janet M Allen
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Malgorzata E Wilinska
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Louise Denvir
- Department of Paediatric Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Fiona Campbell
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, UK
| | - R Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bruce A Buckingham
- Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, CA, USA
| | - Nikki Davis
- Department of Paediatric Endocrinology and Diabetes, Southampton Children's Hospital, Southampton General Hospital, Southampton, UK
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nelly Mauras
- Nemours Children's Health, Jacksonville, FL, USA
| | - Rachel E J Besser
- Oxford University Hospitals NHS Foundation Trust, NIHR Oxford Biomedical Research Centre, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | | | | | - Judy Sibayan
- The Jaeb Center for Health Research, Tampa, FL, USA
| | - Roy W Beck
- The Jaeb Center for Health Research, Tampa, FL, USA
| | - Korey K Hood
- Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, CA, USA
| | - Roman Hovorka
- Department of Pharmaceutical and Health Economics, Mann School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| |
Collapse
|
23
|
Felício J, Moraes L, Lemos G, Souza Í, Vieira G, Silva L, Queiroz N, Souza AC, Melo F, Neto JFA, Britto H, Lemos M, Santos M, Figueiredo P, Motta AR, Reis M, Caldeira G, Leal V, Piani P, Aquino V, Felício K. High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy. Sci Rep 2024; 14:6374. [PMID: 38493259 PMCID: PMC10944468 DOI: 10.1038/s41598-024-56934-1] [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] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.
Collapse
Affiliation(s)
- João Felício
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil.
| | - Lorena Moraes
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Gabriela Lemos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Ícaro Souza
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Giovana Vieira
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Lilian Silva
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Natércia Queiroz
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Ana Carolina Souza
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Franciane Melo
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - João Felício Abrahão Neto
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Hana Britto
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Manuela Lemos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Márcia Santos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Priscila Figueiredo
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Ana Regina Motta
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Melissa Reis
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Gisele Caldeira
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Valéria Leal
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Pedro Piani
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Vitória Aquino
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Karem Felício
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| |
Collapse
|
24
|
Mujahid O, Contreras I, Beneyto A, Vehi J. Generative deep learning for the development of a type 1 diabetes simulator. Commun Med (Lond) 2024; 4:51. [PMID: 38493243 PMCID: PMC10944502 DOI: 10.1038/s43856-024-00476-0] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) simulators, crucial for advancing diabetes treatments, often fall short of capturing the entire complexity of the glucose-insulin system due to the imprecise approximation of the physiological models. This study introduces a simulation approach employing a conditional deep generative model. The aim is to overcome the limitations of existing T1D simulators by synthesizing virtual patients that more accurately represent the entire glucose-insulin system physiology. METHODS Our methodology utilizes a sequence-to-sequence generative adversarial network to simulate virtual T1D patients causally. Causality is embedded in the model by introducing shifted input-output pairs during training, with a 90-min shift capturing the impact of input insulin and carbohydrates on blood glucose. To validate our approach, we train and evaluate the model using three distinct datasets, each consisting of 27, 12, and 10 T1D patients, respectively. In addition, we subject the trained model to further validation for closed-loop therapy, employing a state-of-the-art controller. RESULTS The generated patients display statistical similarity to real patients when evaluated on the time-in-range results for each of the standard blood glucose ranges in T1D management along with means and variability outcomes. When tested for causality, authentic causal links are identified between the insulin, carbohydrates, and blood glucose levels of the virtual patients. The trained generative model demonstrates behaviours that are closer to reality compared to conventional T1D simulators when subjected to closed-loop insulin therapy using a state-of-the-art controller. CONCLUSIONS These results highlight our approach's capability to accurately capture physiological dynamics and establish genuine causal relationships, holding promise for enhancing the development and evaluation of therapies in diabetes.
Collapse
Affiliation(s)
- Omer Mujahid
- Modelling, Identification and Control Engineering Laboratory, Institut d'Informatica i Aplicacions, Universitat de Girona, Girona, 17003, Girona, Spain
| | - Ivan Contreras
- Modelling, Identification and Control Engineering Laboratory, Institut d'Informatica i Aplicacions, Universitat de Girona, Girona, 17003, Girona, Spain
| | - Aleix Beneyto
- Modelling, Identification and Control Engineering Laboratory, Institut d'Informatica i Aplicacions, Universitat de Girona, Girona, 17003, Girona, Spain
| | - Josep Vehi
- Modelling, Identification and Control Engineering Laboratory, Institut d'Informatica i Aplicacions, Universitat de Girona, Girona, 17003, Girona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Girona, Spain.
| |
Collapse
|
25
|
Melchiorre CK, Lynes MD, Bhandari S, Su SC, Potts CM, Thees AV, Norris CE, Liaw L, Tseng YH, Lynes MA. Extracellular metallothionein as a therapeutic target in the early progression of Type 1 Diabetes. Cell Stress Chaperones 2024:S1355-8145(24)00057-9. [PMID: 38490439 DOI: 10.1016/j.cstres.2024.03.005] [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] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
Type 1 diabetes (T1D) is characterized by lymphocyte infiltration into the pancreatic islets of Langerhans, leading to the destruction of insulin-producing beta cells and uncontrolled hyperglycemia. In the non-obese diabetic (NOD) murine model of T1D, onset of this infiltration starts several weeks before glucose dysregulation and overt diabetes. Recruitment of immune cells to the islets is mediated by several chemotactic cytokines, including CXCL10, while other cytokines, including SDF-1α, can confer protective effects. Global gene expression studies of the pancreas from prediabetic NOD mice and single cell sequence analysis of human islets from prediabetic, autoantibody positive patients showed an increased expression of metallothionein (MT), a small molecular weight, cysteine-rich metal binding stress response protein. We have shown that beta cells can release MT into the extracellular environment, which can subsequently enhance the chemotactic response of Th1 cells to CXCL10 and interfere with the chemotactic response of Th2 cells to SDF-1α. These effects can be blocked in vitro with a monoclonal anti-MT antibody, clone UC1MT. When administered to NOD mice before the onset of diabetes, UC1MT significantly reduces the development of T1D. Manipulation of extracellular MT may be an important approach to preserving beta cell function and preventing the development of T1D.
Collapse
Affiliation(s)
- Clare K Melchiorre
- Department of Molecular and Cell Biology, University of Connecticut; Storrs, CT, USA
| | - Matthew D Lynes
- Center for Molecular Medicine, MaineHealth Institute for Research, Scarborough, ME 04074, USA
| | - Sadikshya Bhandari
- Department of Molecular and Cell Biology, University of Connecticut; Storrs, CT, USA
| | - Sheng-Chiang Su
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School; Boston, MA, USA; Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Christian M Potts
- Center for Molecular Medicine, MaineHealth Institute for Research, Scarborough, ME 04074, USA
| | - Amy V Thees
- Department of Molecular and Cell Biology, University of Connecticut; Storrs, CT, USA
| | - Carol E Norris
- Department of Molecular and Cell Biology, University of Connecticut; Storrs, CT, USA
| | - Lucy Liaw
- Center for Molecular Medicine, MaineHealth Institute for Research, Scarborough, ME 04074, USA
| | - Yu-Hua Tseng
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School; Boston, MA, USA
| | - Michael A Lynes
- Department of Molecular and Cell Biology, University of Connecticut; Storrs, CT, USA.
| |
Collapse
|
26
|
Tompa A, Faresjö M. Shift in the B cell subsets between children with type 1 diabetes and/or celiac disease. Clin Exp Immunol 2024; 216:36-44. [PMID: 38134245 DOI: 10.1093/cei/uxad136] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023] Open
Abstract
Our purpose was to characterize the pattern of B cell subsets in children with a combined diagnosis of type 1 diabetes (T1D) and celiac disease (C) since children with single or double diagnosis of these autoimmune diseases may differ in peripheral B cell subset phenotype patterns. B cells were analyzed with flow cytometry for the expression of differentiation/maturation markers to identify transitional, naive, and memory B cells. Transitional (CD24hiCD38hiCD19+) and memory Bregs (mBregs; CD24hiCD27+CD19+, CD1d+CD27+CD19+, and CD5+CD1d+CD19+) were classified as B cells with regulatory capacity. Children with a combined diagnosis of T1D and C showed a pattern of diminished peripheral B cell subsets. The B cells compartment in children with combined diagnosis had higher percentages of memory B subsets and Bregs, including activated subsets, compared to children with either T1D or C. Children with combined diagnosis had a lower percentage of naive B cells (CD27-CD19+; IgD+CD19+) and an increased percentage of memory B cells (CD27+CD19+; IgD-CD19+). A similar alteration was seen among the CD39+ expressing naive and memory B cells. Memory Bregs (CD1d+CD27+CD19+) were more frequent, contrary to the lower percentage of CD5+ transitional Bregs in children with a combined diagnosis. In children with either T1D or C, the peripheral B cell compartment was dominated by naive cells. Differences in the pattern of heterogeneous peripheral B cell repertoire subsets reflect a shifting in the B cell compartment between children with T1D and/or C. This is an immunological challenge of impact on the pathophysiology of these autoimmune diseases.
Collapse
Affiliation(s)
- Andrea Tompa
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Division of Diagnostics, Region Jönköping County, Jönköping, Sweden
| | - Maria Faresjö
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Life Sciences, Division of Systems and Synthetic Biology, Chalmers University of Technology, Gothenburg, Sweden
| |
Collapse
|
27
|
Bai H, He N, Zhang Y, Ahmad A, Yang XX, Ma Y, Liang LJ. Quality of Life and Glucose Regulation in Pediatric Patients with Type 1 Diabetes: A Study in the Ningxia Hui Autonomous Region. Diabetes Metab Syndr Obes 2024; 17:1267-1278. [PMID: 38496005 PMCID: PMC10944302 DOI: 10.2147/dmso.s446387] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Objective In this study, we aimed to evaluate the current status of the quality of life (QOL) of pediatric patients and plasma glucose concentration regulation in children with type 1 diabetes (T1DM) in the Ningxia Hui autonomous region. Methods The study involved children with T1DM admitted to the General Hospital of Ningxia Medical University between October 2011 and October 2021. The children and their parents completed general information and quality of life (QOL) questionnaires. The regulation of plasma glucose concentration was assessed based on HbA1c levels, and plasma glucose and QOL-influencing components were investigated. Results Among the 136 pediatric patients diagnosed with T1DM, the mean glycated hemoglobin (HbA1c) level was recorded at 8.7% (7.2%, 10.5%). A breakdown of the patient cohort revealed that 44 patients (32.4%) demonstrated good regulation of plasma glucose, 33 patients (24.3%) exhibited acceptable glycemic control, and 59 patients (43.3%) displayed poor regulation of plasma glucose. The control of plasma glucose in pediatric patients diagnosed with T1DM was affected by the duration of the disease, the patient's age, the frequency of daily plasma glucose measurements, the use of CGM, diabetic ketoacidosis (DKA), and the education level of the mother. The control of plasma glucose, dietary management, DKA, the ability to learn, and health education are interfering factors of quality of life in children diagnosed with T1DM. Effective control of plasma glucose may ensure the QOL in children with T1DM, and DKA was the risk factor for QOL. Conclusion In Ningxia, the regulation of plasma glucose in pediatric and adolescent patients with T1DM remains suboptimal, leading to poor QOL. There is a pressing need to enhance glucose regulation and QOL through comprehensive strategies, which include reinforced dietary management, rigorous monitoring of plasma glucose levels, and heightened health education levels.
Collapse
Affiliation(s)
- Hua Bai
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Na He
- PKUFH-NINGXIA Women Children’s Hospital, Yinchuan, 750001, People’s Republic of China
| | - Yan Zhang
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Aqsa Ahmad
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Xing-Xing Yang
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Yan Ma
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Li-Jun Liang
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| |
Collapse
|
28
|
Trivedi P, Jhala G, De George DJ, Chiu C, Selck C, Ge T, Catterall T, Elkerbout L, Boon L, Joller N, Kay TW, Thomas HE, Krishnamurthy B. TIGIT acts as an immune checkpoint upon inhibition of PD1 signaling in autoimmune diabetes. Front Immunol 2024; 15:1370907. [PMID: 38533515 PMCID: PMC10964479 DOI: 10.3389/fimmu.2024.1370907] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction Chronic activation of self-reactive T cells with beta cell antigens results in the upregulation of immune checkpoint molecules that keep self-reactive T cells under control and delay beta cell destruction in autoimmune diabetes. Inhibiting PD1/PD-L1 signaling results in autoimmune diabetes in mice and humans with pre-existing autoimmunity against beta cells. However, it is not known if other immune checkpoint molecules, such as TIGIT, can also negatively regulate self-reactive T cells. TIGIT negatively regulates the CD226 costimulatory pathway, T-cell receptor (TCR) signaling, and hence T-cell function. Methods The phenotype and function of TIGIT expressing islet infiltrating T cells was studied in non-obese diabetic (NOD) mice using flow cytometry and single cell RNA sequencing. To determine if TIGIT restrains self-reactive T cells, we used a TIGIT blocking antibody alone or in combination with anti-PDL1 antibody. Results We show that TIGIT is highly expressed on activated islet infiltrating T cells in NOD mice. We identified a subset of stem-like memory CD8+ T cells expressing multiple immune checkpoints including TIGIT, PD1 and the transcription factor EOMES, which is linked to dysfunctional CD8+ T cells. A known ligand for TIGIT, CD155 was expressed on beta cells and islet infiltrating dendritic cells. However, despite TIGIT and its ligand being expressed, islet infiltrating PD1+TIGIT+CD8+ T cells were functional. Inhibiting TIGIT in NOD mice did not result in exacerbated autoimmune diabetes while inhibiting PD1-PDL1 resulted in rapid autoimmune diabetes, indicating that TIGIT does not restrain islet infiltrating T cells in autoimmune diabetes to the same degree as PD1. Partial inhibition of PD1-PDL1 in combination with TIGIT inhibition resulted in rapid diabetes in NOD mice. Discussion These results suggest that TIGIT and PD1 act in synergy as immune checkpoints when PD1 signaling is partially impaired. Beta cell specific stem-like memory T cells retain their functionality despite expressing multiple immune checkpoints and TIGIT is below PD1 in the hierarchy of immune checkpoints in autoimmune diabetes.
Collapse
Affiliation(s)
- Prerak Trivedi
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
| | - Gaurang Jhala
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
| | - David J. De George
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Chris Chiu
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
| | - Claudia Selck
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Tingting Ge
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Tara Catterall
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
| | - Lorraine Elkerbout
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
| | | | - Nicole Joller
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Thomas W. Kay
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Helen E. Thomas
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Balasubramanian Krishnamurthy
- Immunology and Diabetes Unit, St Vincent’s Institute, Fitzroy, VIC, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| |
Collapse
|
29
|
Calcaterra V, Mameli C, Macedoni M, De Silvestri A, Sgambetterra L, Nosenzo F, Redaelli FC, Petitti A, Bosetti A, Zuccotti G. Investigating the connection among thyroid function, sensitivity to thyroid hormones, and metabolic syndrome in euthyroid children and adolescents affected by type 1 diabetes. J Pediatr Endocrinol Metab 2024; 0:jpem-2023-0565. [PMID: 38462926 DOI: 10.1515/jpem-2023-0565] [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] [Received: 12/23/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES A connection between thyroid hormones (THs) and diverse metabolic pathways has been reported. We evaluated thyroid function and tissue sensitivity to THs in children and adolescents with T1D in comparison to euthyroid controls. Additionally, we investigate whether a relationship exists between sensitivity indices and metabolic parameters. METHODS A retrospective analysis was conducted on 80 pediatric patients diagnosed with T1D. Clinical parameters, TSH, FT3, FT4, and the presence of MS were documented. Additionally, indices of peripheral sensitivity (FT3/FT4 ratio) and central sensitivity (TSH index, TSHI; TSH T4 resistance index, TT4RI; TSH T3 resistance index, TT3RI) were assessed. Thirty healthy subjects were considered as controls. RESULTS The overall prevalence of MS was 7.27 %, with MS identified in 8 out of 80 (10 %) T1D subjects; none of the controls manifested MS (p<0.01). No significant differences were observed in indexes of tissue sensitivity to THs between subjects with or without MS (all p>0.05). Correlations between THs and indexes of THs tissue sensitivity and metabolic parameters in controls and T1D patients were noted. CONCLUSIONS This study affirms a heightened prevalence of MS in children with T1D compared to controls and underscores the potential role of THs in maintaining metabolic equilibrium.
Collapse
Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia Pavia, Italy
- Department of Pediatrics, Buzzi Children's Hospital Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, Milano, Italy
| | | | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Federico Nosenzo
- Department of Pediatrics, Buzzi Children's Hospital Milan, Italy
| | | | - Agnese Petitti
- Department of Pediatrics, Buzzi Children's Hospital Milan, Italy
| | | | - Gianvincenzo Zuccotti
- Department of Pediatrics, Buzzi Children's Hospital Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, Milano, Italy
| |
Collapse
|
30
|
Vurallı D, Jalilova L, Alikaşifoğlu A, Özön ZA, Gönç EN, Kandemir N. Cardiovascular Risk Factors in Adolescents with Type 1 Diabetes: Prevalence and Gender Differences. J Clin Res Pediatr Endocrinol 2024; 16:11-20. [PMID: 37559367 PMCID: PMC10938523 DOI: 10.4274/jcrpe.galenos.2023.2023-12-12] [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: 03/02/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Objective Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in patients with type 1 diabetes (T1D). Children with T1D have a similar or higher prevalence of being overweight (OW) or obese (Ob) compared to healthy peers. The aim of this study was to determine the prevalence of CVD risk factors in children and adolescents with T1D and the impact of obesity and sex differences on these factors. Methods Data of patients aged 10-21 years and who had been using intensive insulin therapy with a diagnosis of T1D for at least three years were evaluated. Patients were divided into normal weight (NW), OW and Ob groups based on body mass index percentiles. Risk factors for CVD (obesity, dyslipidemia, hypertension) were compared between groups, and impact of gender was also analyzed. Results Data of 365 patients (200 girls, 54.8%), were evaluated. Prevalence of OW/Ob was 25.9% and was significantly higher in girls (30.6% vs 20.1%, p<0.001). Rate of hypertension was highest in OW/Ob girls followed by OW/Ob boys, and similar in NW girls and boys (p=0.003). Mean low density lipoprotein cholesterol (LDL-c) and triglyceride (TG) levels were highest in OW/Ob girls, followed by OW/Ob boys, NW girls and NW boys, respectively (p<0.001 and p<0.001, respectively). Mean high density lipoprotein-cholesterol (HDL-c) levels were similar among groups. Rates of high LDL-c and TG were similar between OW/Ob girls and boys and higher than NW girls, followed by NW boys (p<0.001 and p<0.001, respectively). The rate of low HDL-c was similar in OW/Ob girls and boys, and higher than NW girls, followed by NW boys (p<0.001). Overall, girls were 1.9 times more likely than boys to have two or more risk factors for CVD. Factors associated with risk for CVD in multiple logistic regression analyses were being a girl, followed by higher daily insulin dose, higher hemoglobin A1c, and longer duration of diabetes (r=0.856; p<0.001). Conclusion In spite of the increased prevalence for obesity in both sexes, the trend for CVD risk factors was greater in Ob girls, followed by Ob boys and NW girls. Girls with T1D are more likely to be OW/Ob and to have CVD risk than boys, highlighting the need for early intervention and additional studies to elucidate the causes.
Collapse
Affiliation(s)
- Doğuş Vurallı
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Lala Jalilova
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Ayfer Alikaşifoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Z. Alev Özön
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - E. Nazlı Gönç
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Nurgün Kandemir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Endocrinology, Ankara, Turkey
| |
Collapse
|
31
|
Thirunavukkarasu R, Chitra A, Asirvatham A, Jayalakshmi M. Association of Vitamin D Deficiency and Vitamin D Receptor Gene Polymorphisms with Type 1 Diabetes Risk: A South Indian Familial Study. J Clin Res Pediatr Endocrinol 2024; 16:21-30. [PMID: 37559366 PMCID: PMC10938518 DOI: 10.4274/jcrpe.galenos.2023.2022-12-7] [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: 04/17/2023] [Accepted: 07/26/2023] [Indexed: 03/12/2024] Open
Abstract
Objective Vitamin D is a potent immune modulator and is associated with autoimmune diseases, including type 1 diabetes (T1D). The vitamin D levels and its receptor gene polymorphisms together in T1D are not yet investigated in the South Indian population. The present study focused on exploring the significance of vitamin D levels and vitamin D receptor (VDR) gene polymorphisms with the risk of developing T1D in the South Indian population. Methods Patients with T1D and unaffected first-degree relatives (FDRs) were included in this study. Genotyping of VDR polymorphisms at four different loci (FokI- F/f, BsmI- B/b, TaqI- T/t, and ApaI- A/a) was assessed through the amplification refractive mutation system-polymerase chain reaction method. Serum vitamin D levels were measured in 98 T1D patients and 75 age- and sex-matched siblings. Results A total of 120 patients with T1D and 214 FDRs were included. Vitamin D deficiency (VDD) was observed in a higher proportion of T1D patients than in controls (52% vs. 32%; p<0.03). The frequency of the FokI-FF genotype was significantly higher [odds ratio (OR)=1.66; p<0.03] in T1D patients conferring a susceptible association with the disease. Nevertheless, the increased frequency of heterozygous Ff genotype (OR=0.57; p<0.02) among controls may confer a protective association with T1D. Furthermore, the transmission disequilibrium test revealed over-transmission of ApaI-A (T: U=15/5; p<0.006) and BsmI-B alleles (T: U=17/5; p<0.01) and under-transmission of BsmI-b/ApaI-a/TaqI-T haplotype (T: U=5.4/14.4; p=0.04) from parents to T1D patients. Conclusion The present study concludes that VDD is the major contributing risk factor to T1D development in the South Indian population. Furthermore, the FokI-FF genotype, BsmI-B, and ApaI-A alleles were positively associated with T1D. In contrast, the FokI-Ff genotype and BsmI-b/ApaI-a/TaqI-T haplotype were negatively associated with T1D.
Collapse
Affiliation(s)
| | - Ayyappan Chitra
- Government Rajaji Hospital, Institute of Child Health and Research Centre, Madurai, India
| | | | | |
Collapse
|
32
|
Arapovicsné Kiss K, Tóth A, Schandl L, Kiss Z, Winkler G, Kis JT. [Immunotherapy of type 1 diabetes mellitus]. Orv Hetil 2024; 165:363-369. [PMID: 38461453 DOI: 10.1556/650.2024.33000] [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] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
Az 1-es típusú diabetes mellitus krónikus lefolyású, progrediáló természetű
autoimmun betegség. A genetikai, immunológiai és a kezdeti anyagcsere-eltérések
jóval megelőzik a klinikai tünetek jelentkezését, ami már régóta felvetette
annak lehetőségét, hogy a betegség kialakulását késleltessük, megakadályozzuk,
esetleg visszafordítsuk. Sajnos a prevenciót célzó klinikai vizsgálatok sokáig
nem hoztak átütő sikert. A közelmúltban azonban az immunológiai kezelés elérte
azt a stádiumot, amelyben az intervenció előnyei meghaladják a kezeléssel járó
kockázatot. E lehetőségek napi gyakorlatba ültetése, az inzulinkezelés
késleltetésének lehetősége át fogja formálni a betegség kezelésének, illetve az
1-es típusú cukorbetegség tekintetében a nagy kockázatú betegek felkutatásának
eddigi stratégiáját. A szerzők összefoglalják az e kórforma immunterápiájával
kapcsolatos legfontosabb ismereteket. Orv Hetil. 2024; 165(10): 363–369.
Collapse
Affiliation(s)
- Krisztina Arapovicsné Kiss
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Anna Tóth
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Zsófia Kiss
- 2 Betegápoló Irgalmas Rend, Budai Irgalmasrendi Kórház, Allergológia és Immunológia Budapest Magyarország
| | - Gábor Winkler
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
- 3 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - János Tibor Kis
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| |
Collapse
|
33
|
Barnard-Kelly K, Thienel F, Mader JK, Oliver N, Franek E, Vesper I, Dagenbach N, Vogt G, Etter T, Künsting T. A Three-Arm Randomized Controlled Study Comparing Patient-Reported Outcomes in People With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion or Multiple Daily Injections. J Diabetes Sci Technol 2024:19322968241234055. [PMID: 38456441 DOI: 10.1177/19322968241234055] [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: 03/09/2024]
Abstract
BACKGROUND The aim of this study was to compare patient-reported outcomes (PROs) in people with type 1 diabetes using either continuous subcutaneous insulin infusion (CSII) with two different insulin patch pumps or multiple daily injections (MDIs). MATERIALS AND METHODS In this randomized three-arm study, people with type 1 diabetes on MDI therapy were included and used either MDI, the Accu-Chek Solo micropump system (Solo) or Omnipod for 26 weeks. From weeks 26 to 39, all participants used CSII with Solo. Patient-reported outcomes were assessed using the diabetes technology questionnaire (DTQ); in addition, HbA1c values were measured. RESULTS Overall, 181 participants were randomized (61 MDI arm, 62 Solo arm, 58 Omnipod arm) and 142 completed the study. After 26 weeks in the study, the DTQ "change" score in the Solo group (105.9 [100.6-111.2]; baseline-adjusted mean [95% confidence interval]) was significantly higher than in the MDI group (94.8 [89.6-100.0]) (P = .001). The comparison between the Solo group (105.1 [99.1-111.1]) and the Omnipod group (108.7 [103.1-114.4]) showed no significant differences (P = .382). HbA1c increased by 0.2% ± 0.7% in the MDI group and decreased in both pump groups (Solo group -0.2% ± 0.8% and Omnipod group -0.1% ± 0.8%). Differences in HbA1c between the Solo group and the MDI group were significant (P = .009), but not between the Solo group and the Omnipod group (P = .896). CONCLUSIONS This study showed that switching from MDI to CSII improves both psychosocial well-being and physiological outcomes. Furthermore, there were no substantial differences between the established and the recently released patch pump. Trial registration at www.clinicaltrials.gov is NCT03478969.
Collapse
Affiliation(s)
| | - Florian Thienel
- Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Edward Franek
- Central Clinical Hospital of the MSWiA in Warsaw, Warsaw, Poland
| | | | | | | | | | | |
Collapse
|
34
|
Helmink MAG, Hageman SHJ, Eliasson B, Sattar N, Visseren FLJ, Dorresteijn JAN, Harris K, Peters SAE, Woodward M, Szentkúti P, Højlund K, Henriksen JE, Sørensen HT, Serné EH, van Sloten TT, Thomsen RW, Westerink J. Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model. Diabetes Obes Metab 2024. [PMID: 38456579 DOI: 10.1111/dom.15531] [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] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
AIMS To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes. MATERIALS AND METHODS A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank. RESULTS During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts. CONCLUSIONS The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.
Collapse
Affiliation(s)
- Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Sciences, University of Glasgow, Glasgow, UK
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, UK
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik H Serné
- Department of Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| |
Collapse
|
35
|
Li Z, Calhoun P, Rickels MR, Gal RL, Beck RW, Jacobs PG, Clements MA, Patton SR, Castle JR, Martin CK, Gillingham MB, Doyle FJ, Riddell MC. Factors Affecting Reproducibility of Change in Glucose During Exercise: Results From the Type 1 Diabetes and EXercise Initiative. J Diabetes Sci Technol 2024:19322968241234687. [PMID: 38456512 DOI: 10.1177/19322968241234687] [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: 03/09/2024]
Abstract
AIMS To evaluate factors affecting within-participant reproducibility in glycemic response to different forms of exercise. METHODS Structured exercise sessions ~30 minutes in length from the Type 1 Diabetes Exercise Initiative (T1DEXI) study were used to assess within-participant glycemic variability during and after exercise. The effect of several pre-exercise factors on the within-participant glycemic variability was evaluated. RESULTS Data from 476 adults with type 1 diabetes were analyzed. A participant's change in glucose during exercise was reproducible within 15 mg/dL of the participant's other exercise sessions only 32% of the time. Participants who exercised with lower and more consistent glucose level, insulin on board (IOB), and carbohydrate intake at exercise start had less variability in glycemic change during exercise. Participants with lower mean glucose (P < .001), lower glucose coefficient of variation (CV) (P < .001), and lower % time <70 mg/dL (P = .005) on sedentary days had less variable 24-hour post-exercise mean glucose. CONCLUSIONS Reproducibility of change in glucose during exercise was low in this cohort of adults with T1D, but more consistency in pre-exercise glucose levels, IOB, and carbohydrates may increase this reproducibility. Mean glucose variability in the 24 hours after exercise is influenced more by the participant's overall glycemic control than other modifiable factors.
Collapse
Affiliation(s)
- Zoey Li
- JAEB Center for Health Research, Tampa, FL, USA
| | | | - Michael R Rickels
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin L Gal
- JAEB Center for Health Research, Tampa, FL, USA
| | - Roy W Beck
- JAEB Center for Health Research, Tampa, FL, USA
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
| | | | | | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | |
Collapse
|
36
|
Michalek DA, Tern C, Zhou W, Robertson CC, Farber E, Campolieto P, Chen WM, Onengut-Gumuscu S, Rich SS. A multi-ancestry genome-wide association study in type 1 diabetes. Hum Mol Genet 2024:ddae024. [PMID: 38453145 DOI: 10.1093/hmg/ddae024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/22/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2024] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune disease caused by destruction of the pancreatic β-cells. Genome-wide association (GWAS) and fine mapping studies have been conducted mainly in European ancestry (EUR) populations. We performed a multi-ancestry GWAS to identify SNPs and HLA alleles associated with T1D risk and age at onset. EUR families (N = 3223), and unrelated individuals of African (AFR, N = 891) and admixed (Hispanic/Latino) ancestry (AMR, N = 308) were genotyped using the Illumina HumanCoreExome BeadArray, with imputation to the TOPMed reference panel. The Multi-Ethnic HLA reference panel was utilized to impute HLA alleles and amino acid residues. Logistic mixed models (T1D risk) and frailty models (age at onset) were used for analysis. In GWAS meta-analysis, seven loci were associated with T1D risk at genome-wide significance: PTPN22, HLA-DQA1, IL2RA, RNLS, INS, IKZF4-RPS26-ERBB3, and SH2B3, with four associated with T1D age at onset (PTPN22, HLA-DQB1, INS, and ERBB3). AFR and AMR meta-analysis revealed NRP1 as associated with T1D risk and age at onset, although NRP1 variants were not associated in EUR ancestry. In contrast, the PTPN22 variant was significantly associated with risk only in EUR ancestry. HLA alleles and haplotypes most significantly associated with T1D risk in AFR and AMR ancestry differed from that seen in EUR ancestry; in addition, the HLA-DRB1*08:02-DQA1*04:01-DQB1*04:02 haplotype was 'protective' in AMR while HLA-DRB1*08:01-DQA1*04:01-DQB1*04:02 haplotype was 'risk' in EUR ancestry, differing only at HLA-DRB1*08. These results suggest that much larger sample sizes in non-EUR populations are required to capture novel loci associated with T1D risk.
Collapse
Affiliation(s)
- Dominika A Michalek
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Courtney Tern
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Wei Zhou
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, 185 Cambridge Street, Boston, MA 02114, United States
| | - Catherine C Robertson
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Emily Farber
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Paul Campolieto
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Wei-Min Chen
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
- Department of Public Health Sciences, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
- Department of Public Health Sciences, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
- Department of Public Health Sciences, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| |
Collapse
|
37
|
Alleva DG, Delpero AR, Sathiyaseelan T, Murikipudi S, Lancaster TM, Atkinson MA, Wasserfall CH, Yu L, Ragupathy R, Bonami RH, Zion TC. An antigen-specific immunotherapeutic, AKS-107, deletes insulin-specific B cells and prevents murine autoimmune diabetes. Front Immunol 2024; 15:1367514. [PMID: 38515750 PMCID: PMC10954819 DOI: 10.3389/fimmu.2024.1367514] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction The antigen-presenting cell function of insulin-reactive B cells promotes type 1 diabetes (T1D) in non-obese diabetic (NOD) mice by stimulating pathogenic T cells leading to destruction of insulin-producing β-cells of pancreatic islets. Methods/Results To target insulin-reactive B cells, AKS-107, a human IgG1 Fc molecule fused with human insulin A and B chains, was engineered to retain conformational insulin epitopes that bound mouse and human B cell receptors but prevented binding to the insulin metabolic receptor. AKS-107 Fc-mediated deletion of insulin-reactive B cells was demonstrated via ex vivo and in vivo experiments with insulin-reactive B cell receptor transgenic mouse strains, VH125Tg/NOD and Tg125(H+L)/NOD. As an additional immune tolerance feature, the Y16A mutation of the insulin B(9-23) dominant T cell epitope was engineered into AKS-107 to suppress activation of insulin-specific T cells. In mice and non-human primates, AKS-107 was well-tolerated, non-immunogenic, did not cause hypoglycemia even at high doses, and showed an expectedly protracted pharmacokinetic profile. AKS-107 reproducibly prevented spontaneous diabetes from developing in NOD and VH125Tg/NOD mice that persisted for months after cessation of treatment, demonstrating durable immune tolerance. Discussion These preclinical outcomes position AKS-107 for clinical development in T1D prevention settings.
Collapse
Affiliation(s)
- David G. Alleva
- Department of Pharmacology, Akston Biosciences, Inc., Beverly, MA, United States
| | - Andrea R. Delpero
- Department of Pharmacology, Akston Biosciences, Inc., Beverly, MA, United States
| | | | - Sylaja Murikipudi
- Department of Pharmacology, Akston Biosciences, Inc., Beverly, MA, United States
| | - Thomas M. Lancaster
- Department of Pharmacology, Akston Biosciences, Inc., Beverly, MA, United States
| | - Mark A. Atkinson
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, and Diabetes Institute, The University of Florida, Gainesville, FL, United States
| | - Clive H. Wasserfall
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, and Diabetes Institute, The University of Florida, Gainesville, FL, United States
| | - Liping Yu
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Ramya Ragupathy
- Department of Pharmacology, Akston Biosciences, Inc., Beverly, MA, United States
| | - Rachel H. Bonami
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Todd C. Zion
- Department of Pharmacology, Akston Biosciences, Inc., Beverly, MA, United States
| |
Collapse
|
38
|
Giammarino F, Senanayake R, Prahalad P, Maahs DM, Scheinker D. A Machine Learning Model for Week-Ahead Hypoglycemia Prediction From Continuous Glucose Monitoring Data. J Diabetes Sci Technol 2024:19322968241236208. [PMID: 38445628 DOI: 10.1177/19322968241236208] [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: 03/07/2024]
Abstract
BACKGROUND Remote patient monitoring (RPM) programs augment type 1 diabetes (T1D) care based on retrospective continuous glucose monitoring (CGM) data. Few methods are available to estimate the likelihood of a patient experiencing clinically significant hypoglycemia within one week. METHODS We developed a machine learning model to estimate the probability that a patient will experience a clinically significant hypoglycemic event, defined as CGM readings below 54 mg/dL for at least 15 consecutive minutes, within one week. The model takes as input the patient's CGM time series over a given week, and outputs the predicted probability of a clinically significant hypoglycemic event the following week. We used 10-fold cross-validation and external validation (testing on cohorts different from the training cohort) to evaluate performance. We used CGM data from three different cohorts of patients with T1D: REPLACE-BG (226 patients), Juvenile Diabetes Research Foundation (JDRF; 355 patients) and Tidepool (120 patients). RESULTS In 10-fold cross-validation, the average area under the receiver operating characteristic curve (ROC-AUC) was 0.77 (standard deviation [SD]: 0.0233) on the REPLACE-BG cohort, 0.74 (SD: 0.0188) on the JDRF cohort, and 0.76 (SD: 0.02) on the Tidepool cohort. In external validation, the average ROC-AUC across the three cohorts was 0.74 (SD: 0.0262). CONCLUSIONS We developed a machine learning algorithm to estimate the probability of a clinically significant hypoglycemic event within one week. Predictive algorithms may provide diabetes care providers using RPM with additional context when prioritizing T1D patients for review.
Collapse
Affiliation(s)
| | | | - Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
- Department of Management Science and Engineering, School of Engineering, Stanford University, Stanford, CA, USA
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
39
|
Manji J, Pipella J, Brawerman G, Thompson PJ. Exploring Transcriptional Regulation of Beta Cell SASP by Brd4-Associated Proteins and Cell Cycle Control Protein p21. Epigenomes 2024; 8:10. [PMID: 38534794 DOI: 10.3390/epigenomes8010010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Type 1 diabetes (T1D) is a metabolic disease resulting from progressive autoimmune destruction of insulin-producing pancreatic beta cells. Although the majority of beta cells are lost in T1D, a small subset undergoes senescence, a stress response involving growth arrest, DNA damage response, and activation of a senescence-associated secretory phenotype (SASP). SASP in beta cells of the nonobese diabetic (NOD) mouse model of T1D and primary human islets is regulated at the level of transcription by bromodomain extra-terminal (BET) proteins, but the mechanisms remain unclear. To explore how SASP is transcriptionally regulated in beta cells, we used the NOD beta cell line NIT-1 to model beta cell SASP and identified binding partners of BET protein Brd4 and explored the role of the cyclin-dependent kinase inhibitor p21. Brd4 interacted with a variety of proteins in senescent NIT-1 cells including subunits of the Ino80 chromatin remodeling complex, which was expressed in beta cells during T1D progression in NOD mice and in human beta cells of control, autoantibody-positive, and T1D donors as determined from single-cell RNA-seq data. RNAi knockdown of p21 during senescence in NIT-1 cells did not significantly impact viability or SASP. Taken together, these results suggest that Brd4 interacts with several protein partners during senescence in NIT-1 cells, some of which may play roles in SASP gene activation and that p21 is dispensable for the SASP in this beta cell model.
Collapse
Affiliation(s)
- Jasmine Manji
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Jasmine Pipella
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Gabriel Brawerman
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Peter J Thompson
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| |
Collapse
|
40
|
Marino M, Galeazzi T, Gesuita R, Ricci S, Catassi C, Cherubini V, Lionetti E. Differences in Plasma 25-Hydroxyvitamin D Levels at Diagnosis of Celiac Disease and Type 1 Diabetes. Nutrients 2024; 16:743. [PMID: 38474871 DOI: 10.3390/nu16050743] [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] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
AIM The aim of this work is to assess the vitamin D levels, evaluated as plasma 25-hydroxyvitamin D of children with a new diagnosis of celiac disease (CD), of children with a new onset of type 1 diabetes (T1D) and in children with CD at diagnosis of T1D (T1D&CD). METHODS In this single-center observational study, we collected data for four groups of children and adolescents: T1D, CD, T1D&CD, and a control group (CG). The CG included schoolchildren who had negative results during a mass screening campaign for CD and were not diagnosed for T1D, according to RIDI Marche registry data, were considered for the purposes of this study. Plasma 25-hydroxyvitamin D, 25(OH)D2, and 25(OH)D3 were considered as the parameters for evaluating vitamin D nutritional status, and the date of measurement was recorded to analyze vitamin D level seasonality. Vitamin D nutritional status was categorized as follows: severe deficiency (<10 ng/mL), deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), or sufficiency/adequacy (≥30 ng/mL). The Kruskal-Wallis test was used to compare the groups. The association of 25(OH)D levels with health conditions and seasonal differences of 25(OH)D levels was analyzed using a multiple linear regression model. RESULTS The number of children enrolled for the present study was 393: 131 in the CG, 131 CD, 109 T1D, and 22 T1D&CD. Significantly lower levels of vitamin D were displayed for children with CD, T1D, or both the diseases. Interestingly, severe vitamin D deficiency was detected in no children with CD, 1.5% of children in the CG, in 24.4% with T1D, and 31.8% with T1D&CD (p < 0.001). As expected, the CG children vitamin D levels were significantly influenced by seasonality. Contrarily, no seasonal differences were reported in children with CD, T1D, and T1D&CD. Multiple regression analysis showed that children with T1D and T1D&CD had lower 25(OH)D levels of 9.9 ng/mL (95% CI: 5.4; 14.5) and 14.4 ng/mL (95% CI: 6.2-22.7) compared to CG children (p < 0.001). CONCLUSIONS Our results showed low levels of vitamin D diagnosis of T1D, CD, and T1D&CD; however, severe deficiency was only reported in children with T1D and T1D&CD. More studies are needed to better understand the role of this deficiency in children newly diagnosed with CD and T1D.
Collapse
Affiliation(s)
- Monica Marino
- Department of Women's and Children's Health, G. Salesi Hospital, 60123 Ancona, Italy
| | - Tiziana Galeazzi
- Department of Pediatrics, Marche Polytechnic University, 60100 Ancona, Italy
| | - Rosaria Gesuita
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Salima Ricci
- Department of Pediatrics, Women's and Children's Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Marche Polytechnic University, 60121 Ancona, Italy
| | - Carlo Catassi
- Department of Pediatrics, Women's and Children's Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Marche Polytechnic University, 60121 Ancona, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, 60123 Ancona, Italy
| | - Elena Lionetti
- Department of Pediatrics, Women's and Children's Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Marche Polytechnic University, 60121 Ancona, Italy
| |
Collapse
|
41
|
Yu MG, Gordin D, Fu J, Park K, Li Q, King GL. Protective Factors and the Pathogenesis of Complications in Diabetes. Endocr Rev 2024; 45:227-252. [PMID: 37638875 PMCID: PMC10911956 DOI: 10.1210/endrev/bnad030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/29/2023] [Revised: 06/13/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
Chronic complications of diabetes are due to myriad disorders of numerous metabolic pathways that are responsible for most of the morbidity and mortality associated with the disease. Traditionally, diabetes complications are divided into those of microvascular and macrovascular origin. We suggest revising this antiquated classification into diabetes complications of vascular, parenchymal, and hybrid (both vascular and parenchymal) tissue origin, since the profile of diabetes complications ranges from those involving only vascular tissues to those involving mostly parenchymal organs. A major paradigm shift has occurred in recent years regarding the pathogenesis of diabetes complications, in which the focus has shifted from studies on risks to those on the interplay between risk and protective factors. While risk factors are clearly important for the development of chronic complications in diabetes, recent studies have established that protective factors are equally significant in modulating the development and severity of diabetes complications. These protective responses may help explain the differential severity of complications, and even the lack of pathologies, in some tissues. Nevertheless, despite the growing number of studies on this field, comprehensive reviews on protective factors and their mechanisms of action are not available. This review thus focused on the clinical, biochemical, and molecular mechanisms that support the idea of endogenous protective factors, and their roles in the initiation and progression of chronic complications in diabetes. In addition, this review also aimed to identify the main needs of this field for future studies.
Collapse
Affiliation(s)
- Marc Gregory Yu
- Research Division, Joslin Diabetes Center, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Daniel Gordin
- Research Division, Joslin Diabetes Center, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Stenbäckinkatu 9, FI-00029 Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Jialin Fu
- Research Division, Joslin Diabetes Center, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Kyoungmin Park
- Research Division, Joslin Diabetes Center, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Qian Li
- Research Division, Joslin Diabetes Center, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - George Liang King
- Research Division, Joslin Diabetes Center, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
42
|
Embaye J, Hennekes M, Snoek F, de Wit M. Psychometric properties of the Diabetes Eating Problem Survey-Revised among Dutch adults with type 1 diabetes and implications for clinical use. Diabet Med 2024:e15313. [PMID: 38439144 DOI: 10.1111/dme.15313] [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] [Received: 11/10/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
AIMS Disordered eating behaviour (DEB) in people with type 1 diabetes (T1D) can be screened with the Diabetes Eating Problem Survey-Revised (DEPS-R). This study aimed to investigate the psychometric properties of the DEPS-R among Dutch adults with T1D and to explore the individual items alongside the standard cut-off score of ≥20 for clinical use. METHODS The construct validity of the DEPS-R was assessed with an exploratory factor analysis, through principal axis factoring and with Spearman correlations between clinical variables and the DEPS-R. Backward logistic regression identified clinical predictors for DEPS-R scores above the cut-off. DEPS-R item responses were summarized with frequencies, means and standard deviations. RESULTS Participants were 145 adults with T1D, of whom 79.3% were women and 35.9% presented with DEB based on the cut-off. A single-factor solution of the DEPS-R showed good internal consistency, while a three-factor solution showed acceptable to good internal consistency within the factors. A younger age, a higher BMI and more diabetes distress were predictors for a DEPS-R cut-off score of ≥20. Clinically relevant items were identified that contributed minimally to the DEPS-R score. CONCLUSIONS This study supports a single-factor and a three-factor structure of the DEPS-R while also suggesting an item-specific or factor-specific approach in clinical practice.
Collapse
Affiliation(s)
- Jiska Embaye
- Departmant of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mareille Hennekes
- Departmant of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Frank Snoek
- Departmant of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Maartje de Wit
- Departmant of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Gómez AM, Henao C DC, Rebolledo M, Jaramillo P PE, Muñoz V OM, Niño G LM, Yepes C CA. Determination of Time in Range Associated With HbA1c ≤7% in a Prospective Cohort of Patients With Type 1 Diabetes Using Continuous Glucose Monitoring for Three Months. J Diabetes Sci Technol 2024; 18:345-350. [PMID: 35791440 DOI: 10.1177/19322968221108424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Finding a goal of time in range (%TIR) that defines good glycemic control is necessary. Previous retrospective studies suggest good concordance between HbA1c ≤7% with a TIR >70%; however, the studies that included the largest number of patients used blood glucose measurement data with a follow-up time of less than 90 days. This study defined the TIR value that best discriminates HbA1c ≤7%. METHODS We performed a prospective study of diagnostic tests based on a cohort of patients with type 1 diabetes (T1D) treated with a hybrid closed loop (HCL) followed for three months. The ability of %TIR to distinguish patients with HbA1c ≤7% was evaluated through receiver operating characteristic curve analysis. We determined the %TIR cutoff point with the best operating characteristics. RESULTS A total of 118 patients were included (58.1% women, 47% overweight or obese, and 33% with high glycemic variability). A moderate negative correlation (R = -.54, P < .001) was found between %TIR and HbA1c. The discrimination ability was moderate, with an area under the curve of 0.7485 (95% confidence interval = 0.6608-0.8363). The cutoff point that best predicted HbA1c ≤7% was %TIR ≥75.5 (sensitivity 70%, specificity 67%). The findings were similar among those with a coefficient of variation (CV%) ≥36%. CONCLUSIONS Our data suggest that the %TIR adequately identifies patients with HbA1c ≤7%. A target of TIR ≥75%, rather than the currently recommended TIR ≥70%, may be a more suitable value for optimal glycemic control.
Collapse
Affiliation(s)
- Ana María Gómez
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diana Cristina Henao C
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Martín Rebolledo
- Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Esteban Jaramillo P
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Oscar Mauricio Muñoz V
- Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Carlos Augusto Yepes C
- Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
44
|
Kueh MTW, Chew NWS, Al-Ozairi E, le Roux CW. The emergence of obesity in type 1 diabetes. Int J Obes (Lond) 2024; 48:289-301. [PMID: 38092958 PMCID: PMC10896727 DOI: 10.1038/s41366-023-01429-8] [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: 07/18/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 02/28/2024]
Abstract
Obesity, a chronic low-grade inflammatory disease represented by multifactorial metabolic dysfunctions, is a significant global health threat for adults and children. The once-held belief that type 1 diabetes is a disease of people who are lean no longer holds. The mounting epidemiological data now establishes the connection between type 1 diabetes and the subsequent development of obesity, or vice versa. Beyond the consequences of the influx of an obesogenic environment, type 1 diabetes-specific biopsychosocial burden further exacerbates obesity. In the course of obesity management discussions, recurring challenges surfaced. The interplay between weight gain and escalating insulin dependence creates a vicious cycle from which patients struggle to break free. In the absence of weight management guidelines and regulatory approval for this population, healthcare professionals must navigate the delicate balance between benefits and risks. The gravity of this circumstance highlights the importance of bringing these topics to the forefront. In this Review, we discuss the changing trends and the biopsychosocial aspects of the intersection between type 1 diabetes and obesity. We highlight the evidence supporting the therapeutic means (i.e., exercise therapy, nutritional therapy, adjunct pharmacotherapy, and bariatric surgery) and directions for establishing a more robust and safer evidence-based approach.
Collapse
Affiliation(s)
- Martin T W Kueh
- UCD School of Medicine and Medical Science, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, Dublin, Malaysia.
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Medicine, College of Medicine, Jabriya, Kuwait
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland.
| |
Collapse
|
45
|
Deveci AC, Gurnani M, Wolfe-Wylie MC, Regina A, Cordeiro K, Dave MG, Mahmud FH, Hamilton J. Looking at Diabetes Through Different Lenses: Focus Groups Conducted With Somali Canadian Families and Their Health-care Providers. Can J Diabetes 2024; 48:112-119.e3. [PMID: 38056690 DOI: 10.1016/j.jcjd.2023.11.004] [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: 06/19/2023] [Revised: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES In Toronto, many families with Somali backgrounds have children living with type 1 diabetes (T1D). At our clinic, children with African and Caribbean backgrounds have higher glycated hemoglobin than children from European backgrounds. In this study, we explored the experiences and perspectives of Somali Canadian families with children living with T1D, as well as health-care professionals (HCPs) who care for them, to better understand how T1D impacts these families. METHODS We conducted 3 separate focus groups with Somali Canadian parents of children with T1D (n=11), Somali Canadian adolescents with T1D (n=5), and HCPs who treat patients with diabetes (n=9), respectively. A grounded theory approach to data analysis was applied to identify themes. RESULTS Four key themes emerged: 1) the general impact of living with diabetes, 2) the challenges of self-management, 3) uncertainty on whose job it is to manage the diabetes, and 4) how cultural differences between Canada and Somalia impact diabetes management. There was discordance in the perspectives of families and HCPs for all themes, but especially themes 1 and 3. Parents focussed on the social impact of diabetes and behavioural indicators of management success, whereas HCPs emphasized clinical measures. Families believed children should take charge of their diabetes self-management early on, whereas HCPs believed the children were not developmentally ready for this responsibility. CONCLUSIONS Differing perspectives of patients, families, and HCPs may lead to diverging expectations for treatment and management. Families and practitioners must work together to identify barriers to care and build strategies to promote competency and resilience in the self-management of T1D.
Collapse
Affiliation(s)
- Arin C Deveci
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muskaan Gurnani
- University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Margaret C Wolfe-Wylie
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Neonatal & Paediatric Medicine, Orillia Soldiers' Memorial Hospital, Orillia, Ontario, Canada
| | - Andrea Regina
- University of Toronto, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristina Cordeiro
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada
| | - Malini G Dave
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
46
|
Villa-Tamayo MF, Colmegna P, Breton MD. Integration of a Safety Module to Prevent Rebound Hypoglycemia in Closed-Loop Artificial Pancreas Systems. J Diabetes Sci Technol 2024; 18:318-323. [PMID: 37966051 DOI: 10.1177/19322968231212205] [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] [Indexed: 11/16/2023]
Abstract
BACKGROUND With automated insulin delivery (AID) systems becoming widely adopted in the management of type 1 diabetes, we have seen an increase in occurrences of rebound hypoglycemia or generated hypoglycemia induced by the controller's response to rapid glucose rises following rescue carbohydrates. Furthermore, as AID systems aim to enable complete automation of prandial control, algorithms are designed to react even more strongly to glycemic rises. This work introduces a rebound hypoglycemia prevention layer (HypoSafe) that can be easily integrated into any AID system. METHODS HypoSafe constrains the maximum permissible insulin delivery dose based on the minimum glucose reading from the previous hour and the current glucose level. To demonstrate its efficacy, we integrated HypoSafe into the latest University of Virginia (UVA) AID system and simulated two scenarios using the 100-adult cohort of the UVA/Padova T1D simulator: a nominal case including three unannounced meals, and another case where hypoglycemia was purposely induced by an overestimated manual bolus. RESULTS In both simulation scenarios, rebound hypoglycemia events were reduced with HypoSafe (nominal: from 39 to 0, hypo-induced: from 55 to 7) by attenuating the commanded basal (nominal: 0.27U vs. 0.04U, hypo-induced: 0.27U vs. 0.03U) and bolus (nominal: 1.02U vs. 0.05U, hypo-induced: 0.43U vs. 0.02U) within the 30-minute interval after treating a hypoglycemia event. No clinically significant changes resulted for time in the range of 70 to 180 mg/dL or above 180 mg/dL. CONCLUSION HypoSafe was shown to be effective in reducing rebound hypoglycemia events without affecting achieved time in range when combined with an advanced AID system.
Collapse
Affiliation(s)
- María F Villa-Tamayo
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Patricio Colmegna
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
47
|
Kinzel C, Manfras B. The Influence of Digital Affinity on the Continuous Glucose Monitoring System Choice by People With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:438-444. [PMID: 35856406 DOI: 10.1177/19322968221113838] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since several years, continuous glucose monitoring (CGM) systems became a standard of care in patients with intensified conventional treatment (ICT) in many countries. CGM results in an ongoing record of digital information that provides an added value to patients with type 1 diabetes (T1D) and healthcare providers, among others. This implies the patient's acceptance of data analyses and storage and an adjustment on self-management. The aim of the study was to investigate the influence of digital affinity on the CGM use and the choice of a particular system. METHODS In a quantitative survey 2102 patients with T1D were interviewed via an online questionnaire. The study is based on the technology acceptance model (TAM). Self-assessment of digital affinity was correlated with various features of CGM use and preferences. Significance of associations and correlations was tested. RESULTS Digital affinity correlated positively with CGM use for the self-management with ICT. Significant differences were found regarding the use of a particular system suggesting a correlation between digital affinity and the complexity of CGM data portrayal and interconnectivity with smart devices (eg, smartwatches). CONCLUSIONS While suppliers of CGM systems focus on progress regarding the ease of use of their systems, they also provide a developing interconnectivity with smart devices and cloud-based data storage. This requires a higher digital affinity among users. While factors such as recommendations by physicians and coverage by health insurance companies have an impact on the system choice, the data demonstrate a correlation between digital affinity and particular CGM systems.
Collapse
Affiliation(s)
- Carolin Kinzel
- Faculty of Health Management, University of Applied Sciences Neu-Ulm, Neu-Ulm, Germany
| | - Burkhard Manfras
- Internal Medicine, Endocrinology and Diabetology, Medicover MVZ, Ulm, Germany
| |
Collapse
|
48
|
Lanctôt SO, Lovblom LE, Lewis EJH, Morris M, Cardinez N, Scarr D, Bakhsh A, Abuabat MI, Lovshin JA, Lytvyn Y, Boulet G, Bussières A, Brent MH, Paul N, Bril V, Cherney DZI, Perkins BA. Fasted C-Peptide Distribution and Associated Clinical Factors in Adults With Longstanding Type 1 Diabetes: Analysis of the Canadian Study of Longevity in Type 1 Diabetes. Can J Diabetes 2024; 48:89-96. [PMID: 37944665 DOI: 10.1016/j.jcjd.2023.11.001] [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: 11/29/2022] [Revised: 08/01/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Although insulin production is reportedly retained in many people with longstanding type 1 diabetes (T1D), the magnitude and relevance of connecting peptide (C-peptide) production are uncertain. In this study, we aimed to define fasted C-peptide distributions and associated clinical factors. METHODS In a cross-sectional analysis of the Canadian Study of Longevity, fasted serum and urinary C-peptide was measured in 74 patients with longstanding T1D (duration ≥50 years) and 75 age- and sex-matched controls. Extensive phenotyping for complications was performed and patient-reported variables were included. C-peptide distributions were analyzed, and multivariable logistic regression was used to assess the variable association in participants with T1D. RESULTS The 74 participants with T1D had a mean age of 66±8 years, a disease duration of 54 (interquartile range 52 to 58) years, and a glycated hemoglobin (A1C) of 7.4%±0.8% (56.8±9.15 mmol/mol). The 75 controls had a mean age of 65±8 years and an A1C of 5.7%±0.4% (38.4±4.05 mmol/mol). Participants with T1D had lower fasted serum C-peptide than controls (0.013±0.022 vs 1.595±1.099 nmol/L, p<0.001). Of the participants with T1D, C-peptide was detectable in 30 of 73 (41%) serum samples, 32 of 74 (43%) urine samples, and 48 of 74 (65%) for either serum or urine. The variables independently associated with detectable serum or urinary C-peptide were lower total daily insulin requirement (odds ratio 2.351 [for 1 lower unit/kg], p=0.013) and lower hypoglycemia worry score (odds ratio 1.059 [for 1 point lower on the worry subscore of the Hypoglycemia Fear Survey], p=0.030). CONCLUSIONS Although detectable C-peptide in longstanding diabetes was common, the magnitude of concentration was extremely low when compared with age- and sex-matched controls. Despite minimal detectability, its presence is validated by lower insulin requirements and strongly associated with lower hypoglycemia worry.
Collapse
Affiliation(s)
- Sebastien O Lanctôt
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Leif Erik Lovblom
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Evan J H Lewis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Michelle Morris
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Nancy Cardinez
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Daniel Scarr
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Abdulmohsen Bakhsh
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada; Kidney & Pancreas Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mohammad I Abuabat
- Internal Medicine and Critical Care Department, King Abdullah bin Abdulaziz University Hospital, Princess Norah University, Riyadh, Saudi Arabia
| | - Julie A Lovshin
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geneviève Boulet
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Alexandra Bussières
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Michael H Brent
- Faculty of Medicine, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Narinder Paul
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
49
|
Al-Sofiani ME, Petrovski G, Al Shaikh A, Alguwaihes A, Al Harbi M, Al Mohannadi D, Adjene A, Alagha A, Al Remeithi S, Alamuddin N, Arrieta A, Castañeda J, Chaar W, van den Heuvel T, Cohen O. The MiniMed 780G automated insulin delivery system adapts to substantial changes in daily routine: Lessons from real world users during Ramadan. Diabetes Obes Metab 2024; 26:937-949. [PMID: 38151748 DOI: 10.1111/dom.15389] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023]
Abstract
AIM To report on the effectiveness and safety of the MiniMed 780G automated insulin delivery system in real-world users during the month of Ramadan. MATERIALS AND METHODS CareLink Personal data were extracted from MiniMed 780G system users from the Gulf region. Users were included if they had ≥10 days of sensor glucose data during the month of Ramadan 2022 as well as in the month before and after. For the main analysis, continuous glucose monitoring endpoints were aggregated per month and were reported by time of day (daytime: 05.31-18.00 h, and night-time). Additional analyses were performed to study the pace at which the algorithm adapts. RESULTS Glycaemic control was well kept in the 449 included users (mean sensor glucose = 152.6 ± 18.7 mg/dl, glucose management indicator = 7.0 ± 0.4%, time in range = 70.7 ± 11.0%, time below 70 mg/dl = 2.3 ± 2.3%). Albeit some metrics differed from the month before (p < .0001 for all), absolute differences were very small and considered clinically irrelevant. During Ramadan, there was no increased risk of hypoglycaemia during daytime (time below 70 mg/dl = 2.3 ± 2.4%), time in range was highest during daytime (80.0 ± 10.7%, night: 60.4 ± 15.3%), while time above 180 mg/dl was highest during night-time (37.3 ± 16.3%, day: 17.7 ± 10.7%). The algorithm adapted immediately upon lifestyle change. CONCLUSION The MiniMed 780G automated insulin delivery system is effective, safe and fast in adapting to the substantial changes that occur in the lifestyle of people with type 1 diabetes during Ramadan.
Collapse
Affiliation(s)
- Mohammed E Al-Sofiani
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Goran Petrovski
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
- College of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Abdulrahman Al Shaikh
- Internal Medicine and Endocrinology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Abdullah Alguwaihes
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Diabetes Center, Dallah Hospital, Riyadh, Saudi Arabia
| | - Mohammad Al Harbi
- Diabetes Center of Excellence, Care Medical Hospital, Almalaz, Saudi Arabia
- Department of National Diabetes Center, Ministry of Health, Riyadh, Saudi Arabia
| | - Dabia Al Mohannadi
- Division of Endocrinology and Diabetes, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Alero Adjene
- Department of Diabetes and Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, UAE
| | - Abdulmoeen Alagha
- Internal Medicine and Endocrinology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sareea Al Remeithi
- Division of Pediatric Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Naji Alamuddin
- Department of Internal Medicine, King Hamad University Hospital, Manama, Bahrain
- Department of Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, Manama, Bahrain
| | - Arcelia Arrieta
- Diabetes Operating Unit, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Javier Castañeda
- Diabetes Operating Unit, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Wael Chaar
- Clinical Research and Medical Science, Diabetes Operating Unit, Medtronic Saudi Arabia, Riyadh, Saudi Arabia
| | - Tim van den Heuvel
- Diabetes Operating Unit, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Ohad Cohen
- Diabetes Operating Unit, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| |
Collapse
|
50
|
Dori-Dayan N, Cukierman-Yaffe T, Zemet R, Cohen O, Levi K, Mazaki-Tovi S, Yoeli-Ullman R. Insulin requirements during pregnancy in women with type 1 diabetes treated with insulin pump. Diabetes Metab Res Rev 2024; 40:e3771. [PMID: 38404019 DOI: 10.1002/dmrr.3771] [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: 01/06/2022] [Revised: 12/23/2023] [Accepted: 01/01/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Insulin requirement in women with Type 1 diabetes (T1DM) changes throughout pregnancy. The aim of this study was to determine the total change in insulin requirements and the effect of gestational weight gain (GWG) and pre-gestational BMI on insulin requirements during pregnancy in women with T1DM treated with continuous subcutaneous insulin infusion and continuous glucose monitoring. METHODS This historical cohort study included all consecutive women with T1DM who were monitored during pregnancy at the high-risk pregnancy clinic at a tertiary medical center during April 2011-April 2019. One Way Repeated Measures ANOVA with Bonferroni adjustment was conducted to compare the effects of gestational age on insulin requirements and a Two Way Repeated Measures ANOVA was employed to test for the interaction between gestational age intervals and maternal BMI and GWG. RESULTS Data regarding insulin requirements of 185 pregnancies were included in the analyses. There was a significant effect of gestational age on total insulin (Wilks' Lambda = 0.34, F(6,14) = 4.52, p = 0.009), basal insulin (Wilks' Lambda = 0.41, F(6,14) = 3.30, p = 0.031) and bolus insulin (Wilks' Lambda = 0.43, F(6,14) = 3.02, p = 0.041). Total insulin/kg requirements increased by 5.5% from 13-20 weeks to 20-26 weeks, 19% from 20-26 weeks to 26-33 weeks, and 17.4% from 26 to 33 weeks to delivery (p for trend = 0.009). Overall, insulin requirements increased by 42.1% from conception to delivery (p < 0.01). There was no significant main effect of maternal BMI or GWG on insulin requirements. CONCLUSIONS There is a significant increase in insulin requirements per kg during pregnancy in women with T1DM who were treated with an insulin pump.
Collapse
Affiliation(s)
- Nimrod Dori-Dayan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tali Cukierman-Yaffe
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Endocrinology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Roni Zemet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ohad Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Endocrinology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Levi
- Endocrinology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli-Ullman
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|