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Článek

Treatment regimens and glycaemic outcomes in more than 100 000 children with type 1 diabetes (2013-22): a longitudinal analysis of data from paediatric diabetes registries

Zimmermann, Anthony T
Autor Zimmermann, Anthony T Division of Medicine, Lyell McEwin Hospital, Adelaide, SA, Australia. Electronic address: anthony.zimmermann@sa.gov.au
Lanzinger, Stefanie
Autor Lanzinger, Stefanie Institute of Epidemiology and Medical Biometry, Computer Assisted Quality Management, Ulm University, Ulm, Germany German Center for Diabetes Research, Munich-Neuherberg, Munich, Germany
Kummernes, Siv Janne
Autor Kummernes, Siv Janne The Norwegian Childhood Diabetes Registry, Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Lund-Blix, Nicolai A
Autor Lund-Blix, Nicolai A The Norwegian Childhood Diabetes Registry, Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Holl, Reinhard W
Autor Holl, Reinhard W Institute of Epidemiology and Medical Biometry, Computer Assisted Quality Management, Ulm University, Ulm, Germany German Center for Diabetes Research, Munich-Neuherberg, Munich, Germany
Fröhlich-Reiterer, Elke
Autor Fröhlich-Reiterer, Elke Department of Paediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
Maahs, David M
Autor Maahs, David M Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, California, CA, USA
Ebekozien, Osagie
Autor Ebekozien, Osagie T1D Exchange, Boston, MA, USA School of Medicine, University of Mississippi, Jackson, MI, USA
Rompicherla, Saketh
Autor Rompicherla, Saketh T1D Exchange, Boston, MA, USA
Warner, Justin T
Autor Warner, Justin T National Paediatric Diabetes Audit, Noah's Ark Children's Hospital for Wales, Cardiff, UK

The lancet. Diabetes & endocrinology. 2025 ; 13 (1) : 47-56. [pub] 20241129

Lancet Diabetes Endocrinol
ISSN 2213-8595
Medvik
Zdroj

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

Článek

Empagliflozín - posúvame sa od sekundárnej prevencie ku skorej intervencii
[Empagliflozin - moving from secondary prevention to early intervention]

Novodvorský, Peter
Autor Autorita ORCID metabolické centrum s. r. o., Trenčín Centrum diabetologie IKEM, Praha I. interná klinika JLF UK a UNM, Martin

Forum Diabetologicum. 2024 ; 13 (3) : 143-146.

ISSN 1805–3807
Medvik
Zdroj

Empagliflozín je inhibítor sodíkovo-glukózového kotransportéra 2 (SGLT2i – Sodium-GLucose co-Transporter 2 inhibitor) primárne vyvinutý ako perorálne antidiabetikum. Postupne pribudli dôkazy z veľkých randomizovaných klinických štúdií pre multiorgánové benefity empagliflozínu výrazne presahujúce jeho glykémiu znižujúci efekt. V súčasnosti tak máme okrem diabetologickej indikácie aj indikáciu na terapiu srdcového zlyhávania a chronickej obličkovej choroby bez ohľadu na prítomnosť diagnózy diabetu. Tieto skutočnosti zapadajú do konceptu novokoncipovaného kardio-reno-metabolického (CRM – Cardio-Renal-Metabolic) syndrómu, ktorého včasné terapeutické ovplyvnenie práve liekmi ako empagliflozín má významné pozitívne efekty na zdravie celej populácie. V článku sú diskutované relevantné klinické štúdie a dáta z reálnej praxe (RWE – Real World Evidence) pre multiorgánové efekty a indikácie empagliflozínu a ich význam pre klinickú prax.

Empagliflozin is a sodium-glucose co-transporter 2 inhibitor (SGLT2i) primarily developed as an oral antidiabetic drug. Later on, evidence from large randomized controlled trials showed that empagliflozin has multiorgan benefits far exceeding its glucose lowering effects. At present empagliflozin has antidiabetic, cardiac and renal indications whereby the last two mentioned are independent on the presence of the diagnosis of diabetes. These data thus fit into the newly formulated concept of cardio-renal-metabolic (CRM) syndrome (or CKM – cardiovascular-kidney-metabolic syndrome). Targeted and early therapeutic intervention against CRM syndrome, with medications like empagliflozin, has profound positive effects on the health outcomes of the whole population. This article reviews the relevant clinical studies and real world evidence (RWE) data and their impact on clinical practice.

Klíčová slova
empagliflozin,
MeSH
benzhydrylové sloučeniny MeSH
chronická renální insuficience diagnóza farmakoterapie MeSH
diabetes mellitus farmakoterapie MeSH
glifloziny * aplikace a dávkování farmakologie terapeutické užití MeSH
glukosidy MeSH
kardiorenální syndrom farmakoterapie MeSH
kardiovaskulární nemoci farmakoterapie prevence a kontrola MeSH
lidé MeSH
metabolický syndrom farmakoterapie komplikace MeSH
nádory prevence a kontrola MeSH
srdeční selhání farmakoterapie MeSH
urolitiáza prevence a kontrola MeSH
Check Tag
lidé MeSH

Článek

Kanagliflozín v liečbe pacientov s diabetes mellitus 2. typu
[Canagliflozin in the treatment of patients with type 2 diabetes mellitus]

Forum Diabetologicum. 2024 ; 13 (3) : 147-151.

ISSN 1805–3807
Medvik
Zdroj

Inhibítory sodíko-glukózového kotransportéra 2 (SGLT2i), resp. gliflozíny sú modernou skupinou antidiabetických liekov v liečbe pacientov s diabetes mellitus 2. typu (DM2T). Kanagliflozín okrem dobrej glykemickej kontroly, nízkeho rizika hypoglykémie a poklesu telesnej hmotnosti vykazuje signifikantný kardiovaskulárny a nefroprotektívny benefit v liečbe pacientov s DM2T porovnateľný s ostatnými gliflozínmi (empagliflozín, dapagliflozín). Liečba kanagliflozínom sa môže potenciálne spájať s nižším rizikom cievnej mozgovej príhody dôsledkom inhibície SGLT1. Výskyt nežiaducich účinkov, ako sú zvýšené riziko infekcie močových ciest, najmä vaginálne kandidózy u žien, euglykemická ketoacidóza a deplécia objemu spojená s hypotenziou, je porovnateľný v celej skupine gliflozínov.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, gliflozins are a modern class of diabetic medications in the treatment of patients with type 2 diabetes mellitus (T2DM). Apart from good glycemic control, low risk of hypoglycemia and weight loss, canagliflozin has been shown to provide significant cardiovascular and nephroprotective benefit in patients with T2DM co-equal to other gliflozines (empagliflozin, dapagliflozin). Treatment with canagliflozin is potentially associated with lower risk of stroke due to inhibition of SGLT1. Incidence of adverse side effects such as increased risk of urinary infections, mainly vaginal candidosis in female, euglycemic ketoacidosis and volume depletion with hypotension is comparable in whole group of gliflozines.

Článek

Oleuropein and hydroxytyrosol as antidiabetics: a review on extraction method, effectiveness and toxicity effect

Vojenské zdravotnické listy. 2024 ; 93 (4) : 355-363. [pub] 20241202

ISSN 0372-7025
Medvik
Zdroj

Introduction: Olive (Olea uropeae) is a traditional plant containing oleuropein and hydroxytyrosol, which are useful and used empirically for treating diabetes mellitus.Objective: To review the potential of oleuropein and hydroxytyrosol as an evidence base for diabetes potential treatment and safety.Methods: This chapter summarizes several studies available on Pubmed and Google Scholar regarding the characteristic method and extraction method as well as the effectiveness and toxicity of oleuropein and hydroxytyrosol in vitro and in vivo.Result: Oleuropein and hydroxytyrosol are effective antihyperglycemics for treating T2D. They can reduce body weight, basal glycemia, and insulin resistance by stopping the liver from making glucose and stopping the body from absorbing glucose. Several studies have shown that both isolates can control glycemic levels equivalent to free fatty acids and are safe to use.Conclusion: Oleuropein and hydroxytyrosol are extracted by several methods and can be used as potential anti-diabetics with obesity risk factors. Evidence shows that both isolates are safe for both acute and chronic use.