BACKGROUND: Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA1c targets have been set. The aim of this study was to perform a longitudinal analysis of HbA1c, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries. METHODS: In this longitudinal analysis, we obtained data from the Australasian Diabetes Data Network, Czech National Childhood Diabetes Register, Danish Registry of Childhood and Adolescent Diabetes, Diabetes Prospective Follow-up Registry, Norwegian Childhood Diabetes Registry, England and Wales' National Paediatric Diabetes Audit, Swedish Childhood Diabetes Registry, T1D Exchange Quality Improvement Collaborative, and the SWEET initiative. All children (aged ≤18 years) with type 1 diabetes with a duration of longer than 3 months were included. Investigators compared data from 2013 to 2022; analyses performed on data were pre-defined and conducted separately by each respective registry. Data on demographics, HbA1c, treatment regimen, and event rates of diabetic ketoacidosis and severe hypoglycaemia were collected. ANOVA was performed to compare means between registries and years. Joinpoint regression analysis was used to study significant breakpoints in temporal trends. FINDINGS: In 2022, data were available for 109 494 children from the national registries and 35 590 from SWEET. Between 2013 and 2022, the aggregated mean HbA1c decreased from 8·2% (95% CI 8·1-8·3%; 66·5 mmol/mol [65·2-67·7]) to 7·6% (7·5-7·7; 59·4mmol/mol [58·2-60·5]), and the proportion of participants who had achieved HbA1c targets of less than 7% (<53 mmol/mol) increased from 19·0% to 38·8% (p<0·0001). In 2013, the aggregate event rate of severe hypoglycaemia rate was 3·0 events per 100 person-years (95% CI 2·0-4·9) compared with 1·7 events per 100 person-years (1·0-2·7) in 2022. In 2013, the aggregate event rate of diabetic ketoacidosis was 3·1 events per 100 person-years (95% CI 2·0-4·8) compared with 2·2 events per 100 person-years (1·4-3·4) in 2022. The proportion of participants with insulin pump use increased from 42·9% (95% CI 40·4-45·5) in 2013 to 60·2% (95% CI 57·9-62·6) in 2022 (mean difference 17·3% [13·8-20·7]; p<0·0001), and the proportion of participants using continuous glucose monitoring (CGM) increased from 18·7% (95% CI 9·5-28·0) in 2016 to 81·7% (73·0-90·4) in 2022 (mean difference 63·0% [50·3-75·7]; p<0·0001). INTERPRETATION: Between 2013 and 2022, glycaemic outcomes have improved, parallel to increased use of diabetes technology. Many children had HbA1c higher than the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 target. Reassuringly, despite targeting lower HbA1c, severe hypoglycaemia event rates are decreasing. Even for children with type 1 diabetes who have access to specialised diabetes care and diabetes technology, further advances in diabetes management are required to assist with achieving ISPAD glycaemic targets. FUNDING: None. TRANSLATIONS: For the Norwegian, German, Czech, Danish and Swedish translations of the abstract see Supplementary Materials section.
- MeSH
- diabetes mellitus 1. typu * epidemiologie krev farmakoterapie MeSH
- dítě MeSH
- glykovaný hemoglobin * analýza MeSH
- hypoglykemie epidemiologie MeSH
- hypoglykemika * terapeutické užití MeSH
- kojenec MeSH
- krevní glukóza * analýza MeSH
- lidé MeSH
- longitudinální studie MeSH
- mladiství MeSH
- předškolní dítě MeSH
- registrace * statistika a číselné údaje MeSH
- regulace glykemie statistika a číselné údaje metody MeSH
- výsledek terapie 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
Klinický problém hypoglykémie je prítomný v diabetológii už od objavu inzulínu pred viac ako 100 rokmi. Nové technológie v manažmente diabetu, akými sú kontinuálne monitorovanie glukózy (Continuous Glucose Monitoring – CGM) alebo inzulínové pumpy integrované s CGM technológiou do hybridných uzavretých systémov na podávanie inzulínu (Advanced Hybrid Closed Loop Systems – AHCL) majú jednoznačné dôkazy pre signifikantnú a klinicky relevantnú redukciu výskytu hypoglykémie. CGM technológia, okrem samotného efektu na redukciu výskytu hypoglykémie, pomohla v prvom rade odhaliť jej skutočnú a predtým nepoznanú mieru výskytu. Autor v prehľadovom článku diskutuje relevantné klinické štúdie a dáta z reálnej praxe (Real World Evidence – RWE) a ich význam pre klinickú prax.
The clinical problem of hypoglycaemia has been with us since the discovery of insulin more than 100 years ago. Modern diabetes technologies, such as continuous glucose monitoring (CGM) or advanced hybrid closed loop systems (AHCL), have unequivocal evidence for significant and clinically meaningful reduction of hypoglycaemia. On top of that, CGM technology has helped us to discover the real extent of the hypoglycaemia ‘problem’ in the lives of our patients. This article reviews the relevant clinical studies and real world evidence data and their impact on clinical practice.
- MeSH
- cvičení MeSH
- diabetes mellitus 1. typu komplikace terapie MeSH
- hypoglykemie prevence a kontrola MeSH
- inzulinové infuzní systémy * MeSH
- lidé MeSH
- pohybová aktivita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- teplizumab,
- MeSH
- diabetes mellitus 1. typu * diagnóza prevence a kontrola terapie MeSH
- diabetes mellitus MeSH
- glykovaný hemoglobin analýza MeSH
- humanizované monoklonální protilátky terapeutické užití MeSH
- kontinuální monitorování glukózy MeSH
- krevní glukóza MeSH
- lidé MeSH
- regulace glykemie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
AIMS/HYPOTHESIS: Monogenic diabetes is estimated to account for 1-6% of paediatric diabetes cases in primarily non-consanguineous populations, while the incidence and genetic spectrum in consanguineous regions are insufficiently defined. In this single-centre study we aimed to evaluate diabetes subtypes, obtain the consanguinity rate and study the genetic background of individuals with syndromic and neonatal diabetes in a population with a high rate of consanguinity. METHODS: Data collection was carried out cross-sectionally in November 2021 at the paediatric diabetic clinic, Dr Jamal Ahmad Rashed Hospital, in Sulaimani, Kurdistan, Iraq. At the time of data collection, 754 individuals with diabetes (381 boys) aged up to 16 years were registered. Relevant participant data was obtained from patient files. Consanguinity status was known in 735 (97.5%) participants. Furthermore, 12 families of children with neonatal diabetes and seven families of children with syndromic diabetes consented to genetic testing by next-generation sequencing. Prioritised variants were evaluated using the American College of Medical Genetics and Genomics guidelines and confirmed by Sanger sequencing. RESULTS: A total of 269 of 735 participants (36.5%) with known consanguinity status were offspring of consanguineous families. An overwhelming majority of participants (714/754, 94.7%) had clinically defined type 1 diabetes (35% of them were born to consanguineous parents), whereas only eight (1.1%) had type 2 diabetes (38% consanguineous). Fourteen (1.9%) had neonatal diabetes (50% consanguineous), seven (0.9%) had syndromic diabetes (100% consanguineous) and 11 (1.5%) had clinically defined MODY (18% consanguineous). We found that consanguinity was significantly associated with syndromic diabetes (p=0.0023) but not with any other diabetes subtype. The genetic cause was elucidated in ten of 12 participants with neonatal diabetes who consented to genetic testing (homozygous variants in GLIS3 [sibling pair], PTF1A and ZNF808 and heterozygous variants in ABCC8 and INS) and four of seven participants with syndromic diabetes (homozygous variants in INSR, SLC29A3 and WFS1 [sibling pair]). In addition, a participant referred as syndromic diabetes was diagnosed with mucolipidosis gamma and probably has type 2 diabetes. CONCLUSIONS/INTERPRETATION: This unique single-centre study confirms that, even in a highly consanguineous population, clinically defined type 1 diabetes is the prevailing paediatric diabetes subtype. Furthermore, a pathogenic cause of monogenic diabetes was identified in 83% of tested participants with neonatal diabetes and 57% of participants with syndromic diabetes, with most variants being homozygous. Causative genes in our consanguineous participants were markedly different from genes reported from non-consanguineous populations and also from those reported in other consanguineous populations. To correctly diagnose syndromic diabetes in consanguineous populations, it may be necessary to re-evaluate diagnostic criteria and include additional phenotypic features such as short stature and hepatosplenomegaly.
- MeSH
- diabetes mellitus 1. typu * epidemiologie genetika MeSH
- diabetes mellitus 2. typu * epidemiologie genetika diagnóza MeSH
- dítě MeSH
- kohortové studie MeSH
- lidé MeSH
- mutace genetika MeSH
- nemoci novorozenců * genetika MeSH
- novorozenec MeSH
- pokrevní příbuzenství MeSH
- proteiny přenášející nukleosidy genetika MeSH
- senioři MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Irák MeSH
Systémy pro automatické podávání inzulinu (AID) představují velký pokrok v léčbě diabetu mellitu 1. typu. Podávání inzulinu automatizují integrací kontinuálního monitorování glukózy, řídicího algoritmu a činností inzulinové pumpy. Přes jejich pokročilost je nutno ve specifických situacích nastavení přizpůsobit, a to buď využitím zvláštních funkcí, nebo i ruční úpravou dávkování. Článek podává přehled o možnostech úprav v dávkování inzulinu pro případy interkurentního onemocnění, pro konzumaci alkoholu a zvýšenou fyzickou aktivitu pro 4 v Česku dostupné certifikované systémy automatického podávání inzulinu.
Automated insulin delivery systems (AID) represent a major advance in the treatment of type 1 diabetes. These systems automate insulin delivery by integrating continuous glucose monitoring, control algorithms and insulin pump actions. Despite their advances, there is a need to adjust the settings in specific situations, either by using special features or even by manually adjusting the dose. The article provides an overview of the possibilities of adjustments in the insulin dosing for intercurrent disease, alcohol consumption and increased physical activity for four certified automatic insulin delivery systems available in the Czech Republic.
- MeSH
- diabetes mellitus 1. typu diagnóza farmakoterapie metabolismus MeSH
- diabetes mellitus 2. typu diagnóza farmakoterapie metabolismus MeSH
- diabetes mellitus * diagnóza farmakoterapie klasifikace metabolismus prevence a kontrola MeSH
- diabetické angiopatie diagnóza klasifikace MeSH
- farmakoterapie klasifikace metody MeSH
- gestační diabetes diagnóza farmakoterapie metabolismus MeSH
- hypoglykemie diagnóza etiologie MeSH
- inzulinová rezistence MeSH
- komplikace diabetu diagnóza klasifikace prevence a kontrola MeSH
- Publikační typ
- přehledy MeSH
