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, Type 1 * epidemiology blood drug therapy MeSH
- Child MeSH
- Glycated Hemoglobin * analysis MeSH
- Hypoglycemia epidemiology MeSH
- Hypoglycemic Agents * therapeutic use MeSH
- Infant MeSH
- Blood Glucose * analysis MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Adolescent MeSH
- Child, Preschool MeSH
- Registries * statistics & numerical data MeSH
- Glycemic Control statistics & numerical data methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Glucagon-Like Peptide-1 Receptor Agonists therapeutic use MeSH
- Sodium-Glucose Transporter 2 Inhibitors therapeutic use MeSH
- Insulin Resistance MeSH
- Comorbidity MeSH
- Humans MeSH
- Metabolic Syndrome * etiology complications therapy MeSH
- Microbiota MeSH
- Mitochondrial Diseases complications MeSH
- Oxidative Stress MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Although sodium-glucose cotransporter 2 inhibitors reduce the risk of cardiovascular death or worsening heart failure (HF) in patients with chronic HF, there are limited data on initiation in hospitalized patients with HF. DAPA ACT HF-TIMI 68 (Dapagliflozin and Effect on Cardiovascular Events in Acute Heart Failure - Thrombolysis in Myocardial Infarction 68) is an international, randomized, double-blind trial evaluating the initiation of dapagliflozin (10 mg daily) vs placebo in 2,401 patients hospitalized for acute HF. Patients were enrolled irrespective of left ventricular ejection fraction, type 2 diabetes status, or chronicity of HF (de novo and worsening chronic HF). Randomized participants receive blinded treatment for 2 months. The primary efficacy endpoint is time to first occurrence of cardiovascular death or worsening HF (worsening HF during the index admission, rehospitalization for worsening HF, or urgent HF visit). Key safety endpoints include symptomatic hypotension and worsening kidney function. This is the first cardiovascular outcomes trial designed specifically to evaluate the efficacy and safety of in-hospital initiation of dapagliflozin in patients hospitalized for the management of acute HF. (Dapagliflozin and Effect on Cardiovascular Events in Acute Heart Failure - Thrombolysis in Myocardial Infarction 68 [DAPA ACT HF-TIMI 68]; NCT04363697; EudraCT # 2022-001262-35).
- MeSH
- Acute Disease MeSH
- Benzhydryl Compounds * therapeutic use administration & dosage MeSH
- Diabetes Mellitus, Type 2 complications drug therapy MeSH
- Double-Blind Method MeSH
- Sodium-Glucose Transporter 2 Inhibitors * therapeutic use MeSH
- Glucosides * therapeutic use administration & dosage MeSH
- Hospitalization MeSH
- Middle Aged MeSH
- Humans MeSH
- Multicenter Studies as Topic MeSH
- Randomized Controlled Trials as Topic MeSH
- Aged MeSH
- Heart Failure * drug therapy physiopathology MeSH
- Stroke Volume MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial Protocol MeSH
This report presents a fatal case of a young female Type I diabetic patient who developed convulsions and loss of consciousness after taking methamphetamine and spending some time in a dance club. During the convulsions, she was given sugar and when no response occurred, her boyfriend who was not experienced in the use of insulin administered a dose of insulin to her. The woman lost consciousness and died despite the efforts of the emergency service. A biochemical analysis revealed a high level of insulin (196.67 mU/L) and low levels of glucose (2.96 mmol/L) and C-peptide (26 pmol/L). Toxicological analysis revealed a methamphetamine concentration of 389 ng/mL and an amphetamine concentration of 19 ng/mL. The forensic perspective of the difficult determination of the contribution of each of the factors to the death, i.e., the pre-existing medical condition (Type I diabetes), the use of methamphetamine, the physical exertion at the dance club, and, finally, the non-indicated administration of insulin, is discussed. The ruling of the court is also reported.
- MeSH
- Unconsciousness chemically induced MeSH
- C-Peptide blood MeSH
- Diabetes Mellitus, Type 1 * MeSH
- Adult MeSH
- Fatal Outcome MeSH
- Hypoglycemic Agents adverse effects MeSH
- Insulin * administration & dosage MeSH
- Blood Glucose analysis MeSH
- Humans MeSH
- Methamphetamine * adverse effects MeSH
- Amphetamine-Related Disorders complications MeSH
- Central Nervous System Stimulants * adverse effects MeSH
- Dancing MeSH
- Physical Exertion MeSH
- Seizures MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Keywords
- tirzepatid,
- MeSH
- Glucagon-Like Peptide-1 Receptor Agonists pharmacology therapeutic use MeSH
- Diabetes Mellitus, Type 2 * drug therapy MeSH
- Hypoglycemic Agents pharmacology therapeutic use MeSH
- Clinical Studies as Topic MeSH
- Anti-Obesity Agents pharmacology therapeutic use MeSH
- Humans MeSH
- Obesity * drug therapy MeSH
- Gastric Inhibitory Polypeptide pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Glucagon-Like Peptide 1 * administration & dosage adverse effects MeSH
- Hypoglycemic Agents administration & dosage adverse effects MeSH
- Drug Interactions MeSH
- Drug Prescriptions * MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- General Practice MeSH
- Insurance, Health, Reimbursement MeSH
- Check Tag
- Humans MeSH
- Keywords
- studie Verify,
- MeSH
- Diabetes Mellitus, Type 2 * drug therapy MeSH
- Hypoglycemic Agents therapeutic use MeSH
- Dipeptidyl-Peptidase IV Inhibitors therapeutic use MeSH
- Clinical Trials as Topic MeSH
- Drug Therapy, Combination methods MeSH
- Humans MeSH
- Metformin therapeutic use MeSH
- Check Tag
- Humans MeSH
Celosvetovo patrí obezita k najrozšírenejším chronickým ochoreniam ako v dospelej, tak aj v detskej a adolescentnej populácii. V súčasnosti je jedným z najvýznamnejších problémov verejného zdravia nielen kvôli narastajúcej prevalencii, ale najmä asociácii so širokým spektrom ďalších chronických a život ohrozujúcich ochorení. Na Slovensku sa prevalencia nadhmotnosti pohybuje v rozmedzí okolo 63 %, prevalencia obezity okolo 29 %. V júni 2024 v Nature Medicine publikovala a zaviedla Európska spoločnosť pre štúdium obezity (European Association for the Study of Obesity – EASO) rámec na zosúladenie diagnostiky, hodnotenia závažnosti a liečby obezity so štandardmi iných chronických ochorení. Ciele liečby chronického ochorenia – (pre)obezity by mali byť holistické, mali by ísť „za“ pokles hmotnosti v kilogramoch, čo prináša so sebou dlhodobé prínosy pre zdravie, duševnú pohodu, fyzické fungovanie a zlepšenie kvality života. Holistické ciele môžeme dosiahnuť zmenou životného štýlu (behaviorálne, nutričné a pohybové intervencie). Zhodnotenie závažnosti ochorenia ovplyvňuje individuálnu liečbu (personalizovaná medicína) a v súčasnosti máme možnosť využívať kombináciu zmeny životného štýlu s farmakoterapiou, prípadne aj bariatrickými chirurgickými postupmi. V ostatnom čase nám pribudlo veľa nových informácií, výsledkov zo zaujímavých klinických štúdií týkajúcich sa farmakologického manažmentu založeného na báze inkretínov. V blízkej budúcnosti sa dočkáme aj ďalších noviniek zacielených na chronický manažment obezity.
Worldwide, obesity is one of the most widespread chronic diseases in the adult, child and adolescent population. It is currently one of the most significant public health problems not only due to its increasing prevalence, but especially due to its association with a wide range of other chronic and life-threatening diseases. In Slovakia, the prevalence of overweight is around 63 %, and the prevalence of obesity is around 29 %. In June 2024, the European Association for the Study of Obesity (EASO) published and introduced a framework to align the diagnosis, assessment of severity and treatment of obesity with the standards of other chronic diseases. The goals of treatment of chronic disease – (pre)obesity should be holistic, they should go “beyond” weight loss in kilograms, which brings with it long-term benefits for health, mental well-being, physical functioning and improved quality of life. Holistic goals can be achieved by changing lifestyle (behavioral, nutritional and exercise interventions). The assessment of the severity of the disease influences individual treatment (personalized medicine) and currently we have the opportunity to use a combination of lifestyle changes with pharmacotherapy, or even bariatric surgical procedures. Recently, we have received a lot of new information, results from interesting clinical studies related to pharmacological management based on incretins. In the near future we will also see other news aimed at chronic management of obesity.
- MeSH
- Glucagon-Like Peptide-1 Receptor Agonists pharmacology therapeutic use MeSH
- Anti-Obesity Agents pharmacology therapeutic use MeSH
- Obesity Management methods MeSH
- Humans MeSH
- Obesity * drug therapy MeSH
- Tirzepatide pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Agonisty receptorov pre glukagónu podobný peptid 1 (GLP1-RA) sú modernou skupinou antidiabetickej liečby pacientov s diabetes mellitus 2. typu s dokázaným metabolickým, kardioprotektívnym, nefroprotektívnym a hepatoprotektívnym benefitom. V porovnaní s inými antidiabetickými liekmi majú lepší efekt na glykemické parametre pri nízkom riziku hypoglykémie. Významne znižujú telesnú hmotnosť, preto sú indikované aj na liečbu nediabetických pacientov s obezitou. V prípade semaglutidu, podávaného 1-krát týždenne, bol jeho priaznivý účinok na všetky komponenty kardio-reno-hepato-metabolického syndrómu potvrdený v klinických randomizovaných štúdiách programov SUSTAIN a STEP, ako aj v štúdiách SELECT, STEP-HFpEF, STEP-HFpEF DM, FLOW a ESSENCE (prvá fáza).
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a modern group of antidiabetic treatments for patients with type 2 diabetes mellitus with proven metabolic, cardioprotective, nephroprotective, and hepatoprotective benefits. Compared to other anti-diabetic drugs, they have a better effect on glycemic parameters with a low risk of hypoglycemia. They significantly reduce body weight, which is why they are also indicated for the treatment of non-diabetic patients with obesity. In the case of semaglutide, administered once a week, its beneficial effect on all components of the cardio-reno-hepato-metabolic syndrome was confirmed in clinical randomized studies of the SUSTAIN and STEP programs, as well as in the SELECT, STEP-HFpEF, STEP-HFpEF DM, FLOW and ESSENCE studies (first phase).
- Keywords
- semaglutid, nefroprotektivní účinek, hepatoprotektiva,
- MeSH
- Glucagon-Like Peptide-1 Receptor Agonists * pharmacology therapeutic use MeSH
- Diabetes Mellitus, Type 2 * drug therapy MeSH
- Cardiovascular Diseases prevention & control MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
