Od začátku války na Ukrajině přijala Česká republika více než 360 000 uprchlíků (United Nations High Council for Refugees, 2023), z nichž velkou část tvořily děti, včetně dětí s diabetem 1. typu (T1D). Celkem jsme v devíti centrech léčby dětského diabetu od února 2022 do června 2023 registrovali 124 dětí s T1D z Ukrajiny, které jsme následně sledovali ve tříměsíčních intervalech. Během prvního roku jejich pobytu v ČR došlo k významnému zlepšení průměrného HbA1c o 2,2 mmol/mol za ambulantní návštěvu (p=0,01, CI [-3,2; -1,1]). Největší pokles HbA1c jsme pozorovali u skupiny, u které byly nově nasazeny kontinuální monitory glykemie (CGM) (průměrný pokles o 2,9 mmol/mol za ambulantní návštěvu). Naše výsledky ukazují na nezastupitelnou roli CGM v managementu diabetu 1. typu.
Czechia has received over 360 000 refugees since the beginning of the war on Ukraine (United Nations High Council for Refugees, 2023). A majority of those refugees were women and children including children with type 1 diabetes (T1D). Throughout the duration of our study (February 2022 - June 2023) a total of 124 Ukrainian children with T1D presented into one of the 9 participating centers for pediatric diabetes. We followed up these children every 3 months for HbA1c, CGM values, therapy type and anthropologic measures. During the first year of their stay in Czechia, the HbA1c of these children decreased significantly by 2,2 mmol/mol per visit (p=0.01, CI [-3.2; -1.1]). HbA1c decreased the most in children who newly received CGM in Czechia with average decrease of 2,9 mmol/mol per visit. Our results show further underline the importance of CGM use in T1D management.
- MeSH
- analýza dat MeSH
- diabetes mellitus 1. typu * MeSH
- dítě MeSH
- hodnocení výsledků zdravotní péče MeSH
- kontinuální monitorování glukózy * přístrojové vybavení MeSH
- lidé MeSH
- management nemoci MeSH
- ozbrojené konflikty MeSH
- uprchlíci * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Geografické názvy
- Ukrajina MeSH
AIMS: To evaluate glucose control non-inferiority and time benefits of telemedicine follow-up in children with type 1 diabetes (CwD). METHODS: In a single-center 9-month-long randomized controlled study (clinicaltrials.gov NCT05484427), 50 children were randomized to either telemedicine group (TG) followed-up distantly by e-mail, or to face-to-face group (FFG) attending standard personal visits. The primary endpoint was non-inferiority of HbA1c at final visit (level of non-inferiority was set at 5 mmol/mol). The secondary endpoints were subcutaneous glucose monitoring parameters and time consumption from both study subjects' and the physicians' point of view. RESULTS: Non-inferiority of HbA1c in the TG was proven (mean HbA1C 45.8 ± 7.3 [TG] vs. 50.0 ± 12.6 [FFG] mmol/mol, 6.3 vs. 6.7 % DCCT, p = 0.17; between groups HbA1C difference 95 % CI -10.2 to 1.9 mmol/mol). Telemedicine saved time for participants (mean visit duration [MVD] 50 [TG] vs. 247 min [FFG], p < 0.001). There were no other differences between groups neither in CGM parameters nor physician's time consumption (MVD 19 [TG] vs. 20 min [FFG], p = 0.58). CONCLUSIONS: Nine-month telemedicine follow-up of the children with well-controlled T1D is not inferior to standard face-to-face visits. Telemedicine visits saved time for the participants but not for their diabetologists.
AIMS: Our aim was to describe the changes in therapy and diabetes control in Ukrainian war refugee children with diabetes (CwD) during the first year of their stay in Czechia. METHODS: A total of 124 CwD (62 male, 62 female) were enrolled into this observational study. Anthropometric, laboratory and diabetes management data were acquired at baseline and at 3 months intervals for 12 months. All CwD were offered a CGM device during their first visit. Generalized Estimating Equation models were fitted in order to estimate the dynamics of studied characteristics. RESULTS: Median baseline HbA1c was 58 mmol/mol (IQR [48; 73]mmol/mol) (7.5 %, IQR[6.5;8.8]%). The HbA1c decreased significantly throughout the course of the study at a pace of - 2.2 mmol/mol (-0.2 %pt.) per visit (P = 0.01, CI[-3.2;-1.1]). The pace of the decrease in the average HbA1c was significantly higher in the group of CwD who received CGM in Czechia than in those who already had it from Ukraine by 2.9 mmol/mol (0.27 %pt.) per visit (P < 0.001, CI [-4.4; -1.3]). CONCLUSIONS: The steepest decrease in HbA1c was observed in CwD with newly initiated CGM underlining its vital role in improving the glucose control of CwD regardless of their background.
- MeSH
- diabetes mellitus 1. typu * farmakoterapie MeSH
- dítě MeSH
- glykovaný hemoglobin MeSH
- kontinuální monitorování glukózy MeSH
- krevní glukóza MeSH
- lidé MeSH
- selfmonitoring glykemie MeSH
- uprchlíci * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: To explore type 1 diabetes incidence patterns during the pandemic years 2020 and 2021 in Czechia, to compare them to the trends from the previous decade, and to test its association with indicators of containment measures and of pandemic severity (school closing and the all-cause excess mortality). METHODS: The Czech Childhood Diabetes Register is a population-based incidence register recording patients age 0-14.99 years at diabetes onset. Type 1 diabetes incidence in the pandemic period (April 2020-end of observation Dec 2021) was compared by Poisson regression models to the incidence patterns over the past decade 2010-2019. RESULTS: During the pandemic years 2020-2021, 956 children 0-14.99 years old manifested with type 1 diabetes in Czechia. The observed incidence (27.2/100,000/year) was significantly higher than what was expected from the trends over 2010-2019 (incidence rate ratio, IRR = 1.16, 95%CI 1.06-1.28, p = 0.0022). The incidence had a trough during the first lockdown (March-May 2020), then it rose above expected values with no usual summer decrease. The assessed pandemic indicators (school closing and all-cause excess mortality) were not associated with the incidence levels. CONCLUSIONS: The COVID-19 pandemic was associated with a notable upward inflection of the type 1 diabetes incidence curve; the early months of the first lockdown were however hallmarked by a significant dip in new diabetes diagnoses. Long-term observation will show whether the increased incidence originated only from accelerating an advanced preclinical Stage 2 to overt diabetes, or whether the pandemic triggered new cases of islet autoimmunity.
- MeSH
- COVID-19 * epidemiologie MeSH
- diabetes mellitus 1. typu * epidemiologie MeSH
- dítě MeSH
- incidence MeSH
- kojenec MeSH
- kontrola infekčních nemocí MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- pandemie MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
