AIM: To determine whether people with type 1 diabetes (T1D) initiating glucose sensor monitoring experience greater improvements in HbA1c when provided with education on carbohydrate counting and flexible insulin dosing than those who do not receive nutrition education. MATERIALS AND METHODS: Our retrospective observational study included 329 people with T1D initiating glucose sensor monitoring between 2015 and 2021. The participants were divided into two groups: one group attended at least one structured educational session with a registered dietitian (n = 126), while the other group did not receive structured education (n = 203). After 12 months of glucose sensor initiation, we compared glycaemic outcomes and CGM metrics between the two groups. RESULTS: At glucose sensor initiation, both groups with and without education had similar HbA1c levels (7.64% [60.0 mmol/mol] vs. 7.66% [60.2 mmol/mol]). After twelve months, the education group demonstrated greater improvement in glycemic outcomes (HbA1c 7.17% [54.9mmol/mol] vs. 7.37% [57.1 mmol/mol], p < 0.05) and spent significantly more time in the target range than did the group without structured education (68.8% vs. 64.1%, p < 0.05). We observed an inverse correlation between the number of completed educational sessions and HbA1c after 12 months, as well as between the number of educational sessions and the change in HbA1c. CONCLUSIONS: People with T1D who initiated glucose sensor monitoring alongside nutrition education showed greater improvements in HbA1c and increased time spent in the target glucose range compared to individuals who did not receive structured education. TRAIL REGISTRATION: ClinicalTrials.gov identifier: NCT06264271.
- MeSH
- diabetes mellitus 1. typu * krev MeSH
- dospělí MeSH
- glykovaný hemoglobin * analýza metabolismus MeSH
- hypoglykemika aplikace a dávkování MeSH
- inzulin aplikace a dávkování MeSH
- krevní glukóza * analýza metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- regulace glykemie MeSH
- retrospektivní studie MeSH
- selfmonitoring glykemie * MeSH
- vzdělávání pacientů jako téma * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Pohled na sacharidy ve stravě nejen u pacientů s diabetem doznal v posledních letech mnoha změn. Ještě před necelými deseti lety byli pacienti s diabetem od stravy se sníženým obsahem sacharidů odrazováni, podle aktuálních doporučení je podíl sacharidů pro tyto pacienty volen individuálně, bez pevně stanoveného ideálního zastoupení. Zatímco u nediabetické populace může být nízkosacharidová strava módním trendem, u pacientů s diabetem obou typů má strava se sníženým podílem sacharidů (pod 45 % celkového energetického příjmu) již prokázané mnohé pozitivní účinky. U pacientů s diabetem 2. typu mohou přinést benefity dokonce i jiné stravovací vzorce, jako je středomořská, vegetariánská či veganská dieta. Ve stravě pacientů s diabetem 1. typu dostávají sacharidy a jejich počítání nový význam také z důvodu rozmachu flexibilního dávkování inzulinu i moderních technologií. Tento článek je koncipovaný jako přehledový a nemá za cíl preferovat či favorizovat některou z uvedených diet.
The opinion on carbohydrates in diet not only in patients with diabetes changed a lot recently. Not even ten years ago, patients with diabetes were discouraged from low carbohydrate diet, but according to actual recommendations, the carbohydrate amount for these patients is chosen individually, without determination of ideal proportion. While it could be only the modern trend in non-diabetic people, low carbohydrate diet (< 45 % of total energy) has already the evidence of benefits in patients with both types of diabetes. Even other eating patterns such as Mediterranean-style, vegetarian or vegan can bring benefits in type 2. diabetic patients. In type 1. diabetic patients, carbohydrates and it’s counting become more important due to expansion of flexible insulin dosing and technologies. This work is designed as a review article and doesn’t favour any of listed diets.
Background: The aim was to compare the efficacy of real-time continuous glucose monitoring (rtCGM) and intermittently scanned continuous glucose monitoring (isCGM) focusing on glycated hemoglobin (HbA1c) as the primary endpoint. Methods: The CORRIDA LIFE was a 12-month, real-world, nonrandomized study that is part of the CORRIDA clinical trials program. The study compared rtCGM (Dexcom G5 or G6) and isCGM (FreeStyle Libre 14-Day; Abbott) in adults with type 1 diabetes (T1D). Only patients on multiple daily insulin injections or continuous subcutaneous insulin infusion with no automatic functions were included in this study. Primary outcome was the difference in HbA1c between study groups at 12 months. Results: One hundred ninety-one adults with T1D (mean age 40 ± 13 years, HbA1c 8.1% ± 3.4% [65 ± 14 mmol/mol]) participated in this study; 81 patients initiated rtCGM and 110 initiated isCGM. After 12-months, HbA1c was significantly lower with rtCGM versus isCGM (7.1% ± 3.1% [54.1 ± 10.1 mmol/mol] vs. 7.7% ± 3.3% [61.2 ± 12.2 mmol/mol]), P = 0.0001. The percentage of time in hypoglycemia (<70 mg/dL [<3.9 mmol/L]) was lower among rtCGM vs. isCGM participants [4.3% ± 2.8% vs. 6.4% ± 5.3%], P = 0.003). Patients with rtCGM spent less time in clinically significant hypoglycemia (<54 mg/dL [<3.0 mmol/L]) (0.9% ± 1.0% vs. 2.3% ± 2.5%, P < 0.0001) and more time in target range (70-180 mg/dL [3.9-10 mmol/L]) than isCGM users (67.5% ± 14.8% vs. 57.8% ± 17.0%), P = 0.0002. Conclusions: rtCGM was superior to isCGM in HbA1c, hypoglycemia, and other glycemic outcomes. Our findings provide guidance to clinicians when discussing monitoring options with their patients. The study was registered at www.clinicaltrials.gov (NCT04759495).
- MeSH
- diabetes mellitus 1. typu * farmakoterapie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza MeSH
- hypoglykemie * prevence a kontrola farmakoterapie MeSH
- hypoglykemika terapeutické užití MeSH
- inzulin terapeutické užití MeSH
- krevní glukóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- selfmonitoring glykemie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The aim of this trial was to compare the efficacy of real-time and intermittently scanned continuous glucose monitoring (rtCGM and isCGM, respectively) in maintaining optimal glycemic control. RESEARCH DESIGN AND METHODS: In this randomized study, adults with type 1 diabetes (T1D) and normal hypoglycemia awareness (Gold score <4) used rtCGM (Guardian Connect Mobile) or isCGM (FreeStyle Libre) during 4 days of physical activity (exercise phase) and in the subsequent 4 weeks at home (home phase). Primary end points were time in hypoglycemia (<3.9 mmol/L [<70 mg/dL]) and time in range (3.9-10.0 mmol/L [70-180 mg/dL]). The isCGM group wore an additional masked Enlite sensor (iPro2) for 6 days to check for bias between the different sensors used by the rtCGM and isCGM systems. RESULTS: Sixty adults with T1D (mean age 38 ± 13 years; A1C 62 ± 12 mmol/mol [7.8 ± 1.1%]) were randomized to rtCGM (n = 30) or isCGM (n = 30). All participants completed the study. Percentage of time in hypoglycemia (<3.9 mmol/L [<70 mg/dL]) was lower among rtCGM versus isCGM participants in the exercise phase (6.8 ± 5.5% vs. 11.4 ± 8.6%, respectively; P = 0.018) and during the home phase (5.3 ± 2.5% vs. 7.3 ± 4.4%, respectively; P = 0.035). Hypoglycemia differences were significant and most notable during the night. rtCGM participants spent more time in range (3.9-10 mmol/L [70-180 mg/dL]) than isCGM participants throughout both the exercise (78.5 ± 10.2% vs. 69.7 ± 16%, respectively; P = 0.0149) and home (75.6 ± 9.7% vs. 67.4 ± 17.8%, respectively; P = 0.0339) phases. The results were robust to the insignificant bias between rtCGM and isCGM sensors that masked CGM found in the isCGM arm. CONCLUSIONS: rtCGM was superior to isCGM in reducing hypoglycemia and improving time in range in adults with T1D with normal hypoglycemia awareness, demonstrating the value of rtCGM alarms during exercise and in daily diabetes self-management.
- MeSH
- cvičení fyziologie MeSH
- diabetes mellitus 1. typu krev farmakoterapie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza účinky léků metabolismus MeSH
- hypoglykemie krev chemicky indukované MeSH
- hypoglykemika terapeutické užití MeSH
- krevní glukóza analýza účinky léků metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítače do ruky MeSH
- počítačové systémy MeSH
- regulace glykemie přístrojové vybavení metody MeSH
- selfmonitoring glykemie metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
