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Mathieu C, Dandona P, Gillard P, Senior P, Hasslacher C, Araki E, Lind M, Bain SC, Jabbour S, Arya N, Hansen L, Thorén F, Langkilde AM, Luquez C, Manghi FP, Ulla MR, Moisello MA, Visco V, De Lapertoza SG, Solis SE, Farias J, Sposetti G, Gillard P, Abrams P, van Ypersele de Strihou M, Conway J, Pedersen S, Senior P, Liutkus JF, Yip CE, Punthakee Z, Bernier F, Lochnan H, Woo V, Elliott T, Palma J, Merino CS, Vargas AD, Wendisch U, Reichel A, Seufert J, Becker B, Alawi H, Birkenfeld AL, Hasslacher C, Luedemann J, Schaum T, Marck C, Sauter J, Aigner U, Onishi Y, Seino H, Sato Y, Nunoi K, Yamauchi A, Nakashima E, Ikeda H, Shiraiwa T, Yamasaki Y, Yokoyama H, Nakamura K, Noritake M, Miyauchi S, Hakoda T, Hirohata Y, Hasegawa A, Fukumoto Y, Nagashima H, Takihata M, Kamada T, Jinnouchi H, Ono Y, Watanabe T, Ohashi H, Takai M, Seguchi T, Yamazaki K, Maeda H, Iwasaki S, De Valk H, Kooy A, Landewe-Cleuren S, Madziarska K, Stankiewicz A, Wasilewska K, Rudofsky G, Malecki M, Pankowska E, Szyprowska E, Lukaszewicz M, Tokarska L, Bondar I, Karpova I, Ruyatkina L, Zalevskaya A, Sardinov R, Khalimov Y, Sjoberg F, Koskinen P, Curiac D, Lind M, Bach-Kliegel B, Schultes B, Issa BG, Kilvert A, Pereira O, Bain S, Mishra B, Bhatnagar D, Chuck L, Gorson D, Robertson D, Casaubon L, Chaykin L, Frias JP, Hsia S, Jenders R, Lerman S, Segel S, Weissman P, Chang A, Reed J, Madu IJ, Bressler P, Abbott L, Gangi S, Wheeler K, Cohen K, Biggs W, Jabbour S, Karounos D, Menon S, Miers W, Aleppo G, Lefebvre G, Sugimoto D, Ferraro R, Kelly R, Twahirwa M, Case C, Klonoff D, Denker P, Hollander P, Welch M, Leinung M, Kotek L, McGill J, Shlesinger Y, Huffman C, Aronoff S, Lorber D, Terrelonge A, Akhrass F, Bredefeld C, Hershon K, Lenhard J, Donovan D, Stonesifer L, Greenberg C, Ipp E, Bhargava A, Bao S. Efficacy and Safety of Dapagliflozin in Patients With Inadequately Controlled Type 1 Diabetes (the DEPICT-2 Study): 24-Week Results From a Randomized Controlled Trial. Diabetes Care 2018; 41:1938-1946. [PMID: 30026335 DOI: 10.2337/dc18-0623] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This 24-week, double-blinded, phase 3 clinical trial (DEPICT-2; ClinicalTrials.gov, NCT02460978) evaluated efficacy and safety of dapagliflozin as adjunct therapy to adjustable insulin in patients with inadequately controlled type 1 diabetes (HbA1c 7.5-10.5%). RESEARCH DESIGN AND METHODS Patients were randomized 1:1:1 to dapagliflozin 5 mg (n = 271), dapagliflozin 10 mg (n = 270), or placebo (n = 272) plus insulin. Insulin dose was adjusted by investigators according to self-monitored glucose readings, local guidance, and individual circumstances. RESULTS Baseline characteristics were balanced between treatment groups. At week 24, dapagliflozin significantly decreased HbA1c (primary outcome; difference vs. placebo: dapagliflozin 5 mg -0.37% [95% CI -0.49, -0.26], dapagliflozin 10 mg -0.42% [-0.53, -0.30]), total daily insulin dose (-10.78% [-13.73, -7.72] and -11.08% [-14.04, -8.02], respectively), and body weight (-3.21% [-3.96, -2.45] and -3.74% [-4.49, -2.99], respectively) (P < 0.0001 for all). Mean interstitial glucose, amplitude of glucose excursion, and percent of readings within target glycemic range (>70 to ≤180 mg/dL) versus placebo were significantly improved. More patients receiving dapagliflozin achieved a reduction in HbA1c ≥0.5% without severe hypoglycemia compared with placebo. Adverse events were reported for 72.7%, 67.0%, and 63.2% of patients receiving dapagliflozin 5 mg, dapagliflozin 10 mg, and placebo, respectively. Hypoglycemia, including severe hypoglycemia, was balanced between groups. There were more adjudicated definite diabetic ketoacidosis (DKA) events with dapagliflozin: 2.6%, 2.2%, and 0% for dapagliflozin 5 mg, dapagliflozin 10 mg, and placebo, respectively. CONCLUSIONS Dapagliflozin as adjunct therapy to adjustable insulin in patients with type 1 diabetes was well tolerated and improved glycemic control with no increase in hypoglycemia versus placebo but with more DKA events.
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Affiliation(s)
- Chantal Mathieu
- Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
| | - Paresh Dandona
- Department of Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Pieter Gillard
- Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
| | - Peter Senior
- Division of Endocrinology, University of Alberta, Edmonton, Canada
| | | | - Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Marcus Lind
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Stephen C. Bain
- Diabetes Research Unit, Swansea University, Swansea, Wales, U.K
| | - Serge Jabbour
- Division of Endocrinology, Diabetes and Metabolic Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Foltynski P, Ladyzynski P, Pankowska E, Mazurczak K. Efficacy of automatic bolus calculator with automatic speech recognition in patients with type 1 diabetes: A randomized cross-over trial. J Diabetes 2018; 10:600-608. [PMID: 29316338 DOI: 10.1111/1753-0407.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 08/31/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Patients using an insulin pump as part of their diabetes treatment need to calculate insulin bolus doses to compensate for a meal. Some patients do not modify their meal boluses according to changes in the amount and composition of food products in a meal. The lack of correct meal boluses leads to unstable, and therefore harmful, blood glucose levels. The aim of the present study was to test a system supporting bolus determination based on a voice description of a meal. METHODS The bolus calculator developed (VoiceDiab) consists of a smartphone application and three remote servers for automatic speech recognition, text analysis, and insulin dosage calculation. Forty-four people with type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion finished the randomized cross-over study. Patients were randomly allocated to the group in which the VoiceDiab system supported bolus calculation or to an unsupported group, in which patients or their caregivers calculated boluses. After a 14-day washout period, patients from the supported group were switched to the unsupported group, whereas those in the unsupported group were switched to the supported group. RESULTS There was a significant difference between the supported and unsupported groups in the percentage of patients with 2-h postprandial glycemia within the 70-180 mg/dL range (58.6% vs 46.6%, respectively; P = 0.031). CONCLUSIONS The VoiceDiab system improves postprandial glucose control without increasing the time in hyperglycemia or hypoglycemia. Therefore, it may be useful in the treatment of patients with diabetes on intensive insulin therapy.
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Affiliation(s)
- Piotr Foltynski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Ladyzynski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Pankowska
- Department of Pediatrics, Institute of Mother and Child, Warsaw, Poland
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Kordonouri O, Hartmann R, Pankowska E, Rami B, Kapellen T, Coutant R, Lange K, Danne T. Sensor augmented pump therapy from onset of type 1 diabetes: late follow-up results of the Pediatric Onset Study. Pediatr Diabetes 2012; 13:515-8. [PMID: 22487079 DOI: 10.1111/j.1399-5448.2012.00863.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/16/2012] [Accepted: 02/22/2012] [Indexed: 12/24/2022] Open
Abstract
AIM To evaluate the metabolic control and β-cell function 1 yr after the end of the European multicentre randomized Pediatric Onset Study. METHODS Of 154 study patients, 131 were re-examined 24 months after type 1 diabetes onset (49.6% boys, age at onset 8.9 ± 4.3 yrs). Of which, 62 patients belonged to the primary group of the main study applying a sensor-augmented pump system during the first yr and 69 patients to the control group performing conventional insulin pump therapy with self-monitoring blood glucose. HbA1c, fasting blood glucose, and C-peptide were centrally measured (Clinical Trail Registration Number: ISRCTN05450731). RESULTS At 24 months, i.e., 1 yr after the end of the interventional study, 52.4% of the patients used the sensor-augmented pump system, 46.0% conventional pump, and 1.6% multiple daily injections. HbA1c was 7.6 ± 1.3% in the primary and 7.7 ± 1.2% in the control group (p = 0.493). Frequent sensor use during the first yr was associated with statistically insignificant lowering of the HbA1c at 24 months (p = 0.236) as compared with irregular or no sensor use (7.4 ± 1.0% vs. 7.7 ± 1.3%). Although fasting C-peptide was not clearly different between the primary and control group (0.13 ± 0.17 vs. 0.09 ± 0.10 nmol/L, p = 0.121), patients with frequent sensor use had significantly less C-peptide loss within 24 months (C-peptide reduction 0.02 ± 0.18 vs. 0.07 ± 0.11 nmol/L, p = 0.046). There was no difference between the groups regarding daily insulin requirements. CONCLUSION Sensor-augmented pump therapy from onset of diabetes may lead to better long-term glycemic control and help to preserve endogenous β-cell function, if patients comply with frequent use of continuous glucose monitoring.
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Affiliation(s)
- Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus, Auf der Bult, Hannover, Germany.
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Waldron S, Rurik I, Madacsy L, Donnasson-Eudes S, Rosu M, Skovlund SE, Pankowska E, Allgrove J. Good practice recommendations on paediatric training programmes for health care professionals in the EU. Pediatr Diabetes 2012; 13 Suppl 16:29-38. [PMID: 22931222 DOI: 10.1111/j.1399-5448.2012.00910.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Part of the SWEET Project: EU (European Union), Better Control in Paediatric and Adolescent Diabetes: Working to Create Centres of Reference, was specifically to examine the training of health care professionals (HCPs) across the EU. Several types of information were collected during 2009, and these included a literature search, workshops of the SWEET members, examination of the data collected by the Hvidøre Study Group and the Diabetes Attitudes, Wishes, and Needs (DAWN) Youth initiative, and a questionnaire distributed to SWEET members and professional colleagues who cared for children and young people (CYP) with diabetes. It was clear from the information collected that there was no European or global consensus either on a curriculum for the training of the paediatric diabetes multidisciplinary team (MDT) or individual professions in paediatric diabetes. A minority of countries had well-established training but, for the majority, there was little standardisation or accreditation. Moreover, most countries did not have available courses for training the diabetes MDT and training was not mandatory. Of the courses that were available more were accredited for doctors and nurses but fewer for the other professions. As a consequence, the majority of HCP posts in paediatric diabetes do not demand prior experience in the specialty. Standardised accredited training and continuous professional development (CPD) opportunities are severely limited. The SWEET Project supports a standardised, accredited approach to training and CPD of the MDT and for individual professions. As a consequence, a curriculum for the training of the MDT was developed, and this is now ready for implementation.
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Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, Lange K, Knip M, Danne T. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia 2010; 53:2487-95. [PMID: 20711715 DOI: 10.1007/s00125-010-1878-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS The value of managing children with type 1 diabetes using a combination of insulin pump and continuous glucose monitoring starting from diagnosis for improving subsequent glycaemic control and preserving residual beta cell function was determined. METHODS A total of 160 children (aged 1-16 years, mean ± SD: 8.7 ± 4.4 years; 47.5% girls) were randomised to receive insulin pump treatment with continuous glucose monitoring or conventional self-monitoring blood glucose measurements. The primary outcome was the level of HbA(1c) after 12 months. Other analyses included fasting C-peptide, glycaemic variability, sensor usage, adverse events, children's health-related quality of life and parent's wellbeing. RESULTS HbA(1c) was not significantly different between the two groups, but patients with regular sensor use had lower values (mean 7.1%, 95% CI 6.8-7.4%) compared with the combined group with no or low sensor usage (mean 7.6%, 95% CI 7.3-7.9%; p=0.032). At 12 months, glycaemic variability was lower in the sensor group (mean amplitude of glycaemic excursions 80.2 ± 26.2 vs 92.0 ± 33.7; p=0.037). Higher C-peptide concentrations were seen in sensor-treated 12- to 16-year-old patients (0.25 ± 0.12 nmol/l) compared with those treated with insulin pump alone (0.19 ± 0.07 nmol/l; p=0.033). Severe hypoglycaemia was reported only in the group without sensors (four episodes). CONCLUSION/INTERPRETATION Sensor-augmented pump therapy starting from the diagnosis of type 1 diabetes can be associated with less decline in fasting C-peptide particularly in older children, although regular sensor use is a prerequisite for improved glycaemic control. TRIAL REGISTRATION ISRCTN.org ISRCTN05450731 FUNDING Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
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Affiliation(s)
- O Kordonouri
- Bult Diabetes Centre for Children and Adolescents, Kinderkrankenhaus auf der Bult, Janusz-Korczak-Allee 12, D-30173 Hannover, Germany
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Golicki DT, Golicka D, Groele L, Pankowska E. Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetologia 2008; 51:233-40. [PMID: 18060380 DOI: 10.1007/s00125-007-0884-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Accepted: 10/08/2007] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS We investigated the potential effects of the Continuous Glucose Monitoring System (CGMS), as compared with self-monitoring of blood glucose, on glycaemic control in children with type 1 diabetes. METHODS The following electronic databases were searched throughout June 2007: MEDLINE, EMBASE and The Cochrane Library. Additional references were obtained from reviewed articles. Only randomised controlled trials were included. RESULTS We included five trials involving 131 type 1 diabetic patients in the study. Combined data from all trials showed that the CGMS did not significantly reduce HbA1c levels compared with control groups. The pooled weighted mean difference was -0.02% (95% CI -0.29 to 0.25) with a fixed model and remained insignificant in the random effect model. Sensitivity analysis determined that the findings were stable. There was a trend towards a longer time under the CGMS curve for glucose <3.89 mmol/l in the CGMS group compared with the control group (mean difference 49.00 min, 95% CI -18.00 to 116.00). The CGMS significantly increased the number of insulin dose changes per patient per month for those managed with CGMS compared with the control groups (mean difference 6.3 changes, 95% CI 2.88-9.72). CONCLUSIONS/INTERPRETATION The Continuous Glucose Monitoring System is not better than self-monitoring of blood glucose with regard to improvement of metabolic control among type 1 diabetic children. However, due to the small number of participants and methodological limitations of the studies included, findings of this meta-analysis should be interpreted with caution.
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Affiliation(s)
- D T Golicki
- Department of Pharmacoeconomics, Medical University of Warsaw, ul. Pawinskiego 3A, 02-106, Warsaw, Poland.
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