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
INTRODUCTION: The aim of the study was to assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA. METHODS: CwD younger than 19 years with T1D duration >1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups. RESULTS: Data of a total of 3,251 children (mean age 13.4 ± 3.8 years) were analyzed. 2,187 (67.3%) were treated with MDI, 1,064 (32.7%) with insulin pump, 585/1,064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3) and lowest GRI 29.1 (7.8), both p < 0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (nonsignificant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 [IQR 4.5], 50.7 [4.5], and 52.7 [5.7] mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality. CONCLUSION: This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.
- MeSH
- diabetes mellitus 1. typu * farmakoterapie MeSH
- dítě MeSH
- glykovaný hemoglobin MeSH
- hypoglykemika terapeutické užití MeSH
- inzulin terapeutické užití MeSH
- krevní glukóza MeSH
- lidé MeSH
- mladiství MeSH
- regulace glykemie MeSH
- selfmonitoring glykemie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
OBJECTIVE: To compare parameters of glycemic control among three types of hybrid closed loop (HCL) systems in children with T1D (CwD) using population-wide data from the national pediatric diabetes registry ČENDA. METHODS: CwD aged <19 years treated with Medtronic MiniMed 780G (780G), Tandem t:slim X2 (Control-IQ) or do-it-yourself AndroidAPS (AAPS) systems for >12 months and monitored by CGM >70% of the time were included. HbA1c, times in glycemic ranges, and Glycemia Risk Index (GRI) were used for cross-sectional comparison between the HCL systems. RESULTS: Data from 512 CwD were analyzed. 780G, Control-IQ and AAPS were used by 217 (42.4%), 211 (41.2%), and 84 (16.4%) CwD, respectively. The lowest HbA1c value was observed in the AAPS group (44 mmol/mol; IQR 8.0, p<0.0001 vs any other group), followed by Control-IQ and 780G groups (48 (IQR 11) and 52 (IQR 10) mmol/mol, respectively). All of the systems met the recommended criteria for time in range (78% in AAPS, 76% in 780G, and 75% in Control-IQ users). CwD using AAPS spent significantly more time in hypoglycemia (5% vs 2% in 780G and 3% in Control-IQ) and scored the highest GRI (32, IQR 17). The lowest GRI (27, IQR 15) was seen in 780G users. CONCLUSION: Although all HCL systems proved effective in maintaining recommended long-term glycemic control, we observed differences that illustrate strengths and weaknesses of particular systems. Our findings could help in individualizing the choice of HCL systems.
- MeSH
- diabetes mellitus 1. typu * farmakoterapie MeSH
- dítě MeSH
- glykovaný hemoglobin MeSH
- hypoglykemie * chemicky indukované epidemiologie MeSH
- inzulin terapeutické užití MeSH
- inzulinové infuzní systémy MeSH
- krevní glukóza MeSH
- lidé MeSH
- průřezové studie MeSH
- registrace MeSH
- selfmonitoring glykemie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference 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
Úvod: Diabetes je jedním z nejčastějších chronických onemocnění dětského věku. Společným úsilím dětských diabetologických center a ambulancí byl v roce 2013 založen webový longitudinální registr dětského diabetu ČENDA, který se v následujících letech etabloval jako důležitý zdroj informací o průběhu, kompenzaci, terapii a komplikacích diabetu u dětí a adolescentů. Sdělení shrnuje trendy v klíčových parametrech kompenzace diabetu za prvních 8 let trvání registru ČENDA. Výsledky: V roce 2020 registr obsahoval data od 3818 pacientů, tedy přibližně 90 % dětí s diabetem v ČR. Registr ukazuje jednoznačný trend ve snižování HbA1c na populační úrovni, průměrný HbA1c poklesl u dětí s diabetem 1. typu z 66,6 mmol/mol v roce 2013 na 54,7 mmol/mol v roce 2020 (p < 0,001). Toto snížení bylo doprovázeno snížením incidence akutních komplikací diabetu. Hlavními prediktory pro dosažení uspokojivé kontroly diabetu jsou využívání moderních technologií (inzulinových pump a kontinuálních monitorů glykemie), mužské pohlaví a sledování ve větších centrech. Závěr: Prognóza dětí s diabetem 1. typu se v ČR v posledních letech významně zlepšila. Zavádění moderních technologií do klinické praxe a založení registru ČENDA se na tomto pozitivním vývoji velmi pravděpodobně spolupodílejí.
Introduction: Diabetes belongs to the most common chronic diseases in childhood. Web-based national longitudinal pediatric diabetes registry (ČENDA) was established in 2013 by the joint efforts of Czech centers of pediatric diabetes. Since then, the ČENDA registry represents an important source of data on the course, control, therapy and complications of diabetes in children and adolescents. This paper summarizes trends in key parameters of diabetes control over the first 8 years of the ČENDA registry. Results: In 2020, the register contained data from 3818 patients, i. e. approximately 90% of children with diabetes in the Czech Republic. The registry data shows a decreasing trend in HbA1c in children with Type 1 diabetes - the mean HbA1c dropped by 12 mmol/mol from 66.6 mmol/mol in 2013 to 54.7 mmol/mol in 2020 (p < 0.001). This change was accompanied by a reduction in the incidence of acute diabetic complications. Main predictors associated with lower HbA1c were treatment using modern technologies (insulin pumps and continuous glucose monitors), male sex, and care provided at a large diabetes center. Conclusion: The prognosis of Czech children with type 1 diabetes has significantly improved in recent years. The introduction of modern technologies into clinical practice and the establishment of the ČENDA registry have very likely contributed to this positive trend.
OBJECTIVE: Increased access to modern technologies is not always accompanied by a decrease in HbA1c. The aim of this study was to identify changes in the proportion of continuous glucose monitoring (CGM) users since 2017, when general reimbursement for CGM became effective in Czechia, and to test whether HbA1c is associated with the percentage of time spent on CGM. RESEARCH DESIGN AND METHODS: All T1D children in the Czech national ČENDA registry (3197 children) were categorized according to their time spent on CGM and associations with age, sex, center size, and HbA1c were tested with calendar year as a stratification factor. RESULTS: The proportion of children with any CGM use increased from 37.9% in 2017 to 50.3% in 2018 and 74.8% in 2019. Of the CGM users, 16%, 28%, and 41% of the children spent >70% of their time on CGM over the 3 years of the study period, with an overrepresentation of children in the <10 years age group versus the older age groups (p < 0.001). The proportion of CGM users differed among centers and was positively associated with a large center size (>100 patients) (p < 0.001). HbA1c was negatively associated with the time spent on CGM (p < 0.001). CONCLUSIONS: A rapid increase in CGM use was reported over the 3 years after general reimbursement. HbA1c was associated with time spent on CGM, a continuing decrease was observed in the >70% category. Reimbursement for CGM likely contributes to the improvement of T1D control at the population level.
- MeSH
- časové faktory MeSH
- diabetes mellitus 1. typu krev farmakoterapie MeSH
- dítě MeSH
- glykovaný hemoglobin metabolismus MeSH
- hypoglykemika terapeutické užití MeSH
- inzulin terapeutické užití MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- registrace MeSH
- selfmonitoring glykemie * MeSH
- sexuální faktory MeSH
- úhrada zdravotního pojištění MeSH
- věkové faktory MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
