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
Prevalence diabetes mellitus 1. typu u dětí stoupá a diagnostikuje se stále v mladším věku. Jednou z velmi důležitých součástí léčby diabetu je selfmonitoring, který prošel dlouhým, ale zato efektivním vývojem, od domácího měření hodnot glykemie pomocí osobního glukometru, až po glykemické senzory. Hlavním cílem je předejít komplikacím, současně však i pomoci dětem vést plnohodnotný život bez vyřazení z kolektivu svých vrstevníků.
The prevalence of type 1 diabetes mellitus in children is increasing and is being diagnosed at an increasingly younger age. One of the very important components of diabetes treatment is self-monitoring, which has undergone a long but effective development, from home measurement of blood glucose values using a personal glucometer to blood glucose sensors. The main goal is to prevent complications, but at the same time to help children lead a fulfilling life without being excluded from the group of their peers.
- Klíčová slova
- Freestyle Libre, Dexcom,
- MeSH
- diabetes mellitus 1. typu * diagnóza krev prevence a kontrola MeSH
- dítě MeSH
- glykosurie prevence a kontrola MeSH
- ketóza prevence a kontrola MeSH
- komplikace diabetu prevence a kontrola MeSH
- kontinuální monitorování glukózy klasifikace metody přístrojové vybavení MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- selfmonitoring glykemie * klasifikace metody přístrojové vybavení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
AIMS: We investigated whether a short period of tightly controlled low-carbohydrate diet (LCD) leads to higher time in range without increasing the associated risks in children and young people with diabetes (CYPwD). METHODS: Thirty-five (CYPwD) were recruited into this randomized controlled cross-over study (20 female; 20 CSII; age 14.5 ± 2.9 years; HbA1c 48.9 ± 9.4 mmol/mol). The interventions were five and five weeks of ready-made food box deliveries of isocaloric diets in random order: either LCD (94.5 ± 4.7 g/day) or recommended carbohydrate diet (RCD) (191 ± 19.2 g/day). The outcomes were continuous glucose monitoring parameters, anthropometric, laboratory and quality of life (QoL) data. RESULTS: Time in range was significantly higher in the LCD than in the RCD period (77.1 % vs. 73.8 %, P=0.008). Times in hyperglycemia and average glycaemia were significantly lower in the LCD. There was no difference between the diets in time in hypoglycemia or glycemic variability. The subjects' body weight and BMI were significantly lower during the LCD. There was no significant difference in the LDL-cholesterol levels. No significant differences were observed in the self-assessed QoL. CONCLUSIONS: Short-term LCD led to an improvement of glycemic parameters without increasing time in hypoglycemia, disturbing the lipid profile or negatively affecting the quality of life of CYPwD.
- MeSH
- diabetes mellitus 1. typu * dietoterapie krev MeSH
- dieta s omezením sacharidů * metody MeSH
- dítě MeSH
- glykovaný hemoglobin metabolismus analýza MeSH
- klinické křížové studie * MeSH
- krevní glukóza metabolismus analýza MeSH
- kvalita života MeSH
- lidé MeSH
- mladiství MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
AIMS: Autoantibodies against hexokinase 1 (HK1) were recently proposed to be associated with diabetic macular edema (DME). We hypothesized that anti-HK1 autoantibodies can be used as DME markers and to predict DME onset. MATERIALS AND METHODS: Serum from patients with 1) DME, 2) diabetes mellitus (DM), 3) allergies or autoimmunities, and 4) control subjects was tested for anti-HK1 and anti-hexokinase 2 (HK2) autoantibodies by immunoblotting. Patients with DM were prospectively followed for up to nine years, and the association of anti-HK1 antibodies with new-onset DME was evaluated. The vitreous humor was also tested for autoantibodies. RESULTS: Among patients with DME, 32 % were positive for anti-HK1 autoantibodies (42 % of those with underlying type 1 DM and 31 % of those with underlying type 2 DM), and 12 % were positive for anti-HK2 autoantibodies, with only partial overlap of these two groups of patients. Anti-HK1 positive were also 7 % of patients with DM, 6 % of patients with allergies and autoimmunities, and 3 % of control subjects. The latter three groups were anti-HK2 negative. Only one of seven patients with DM who were initially anti-HK1 positive developed DME. CONCLUSIONS: Anti-HK1 autoantibodies can be used as DME markers but fail to predict DME onset.
- MeSH
- autoprotilátky * krev imunologie MeSH
- biologické markery krev MeSH
- diabetes mellitus 1. typu imunologie komplikace krev MeSH
- diabetes mellitus 2. typu imunologie komplikace krev MeSH
- diabetická retinopatie * imunologie krev MeSH
- dospělí MeSH
- hexokinasa * imunologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- makulární edém * imunologie krev MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Diabetes 1. typu (DM1) patří mezi nejčastější chronická onemocnění dětského věku. Jeho incidence u nás dlouhodobě roste. U téměř třetiny z nově diagnostikovaných dětí je při diagnóze přítomna diabetická ketoacidóza (DKA) různého stupně závažnosti. V tomto článku bychom rádi představili pilotní screeningový projekt βetty, který umožňuje odhalit diabetes v jeho preklinických stadiích, a představuje tak účinnou prevenci DKA. Screening, jehož principem je detekce autoprotilátek specifických pro DM1 ze vzorku kapilární krve, je určen všem dětem ve věku od 2 do 18 let.
Type one diabetes (T1D) is one of the most common chronic pediatric diseases with continuously increasing incidence. Approximately one third of newly diagnosed children suffer from diabetic ketoacidosis (DKA). In this article we would like to introduce the βetty project, a pilot T1D screening programme that detects T1D in its early preclinical stages and effectively prevents DKA at T1D onset. The screening can be offered to children from 2 to 18 years of age and is based on T1D specific autoantibody detection in capillary blood.
- MeSH
- autoprotilátky krev MeSH
- diabetes mellitus 1. typu * diagnóza krev patologie prevence a kontrola MeSH
- diabetická ketoacidóza diagnóza epidemiologie prevence a kontrola MeSH
- dítě MeSH
- lidé MeSH
- screeningové diagnostické programy * MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Atherosclerotic cardiovascular disease (ASCVD) is accelerated in people with diabetes. Dyslipidemia, hyperglycemia, oxidative stress, and inflammation play a role via a variety of mechanisms operative in the artery wall. In addition, some unique features predispose people with type 1 diabetes to accelerated atherosclerosis. Various organizations have created guidelines that provide advice regarding screening, risk assessment, and roadmaps for treatment to prevent ASCVD in diabetes. Management of dyslipidemia, especially with statins, has proven to be of immense benefit in the prevention of clinical CVD. However, since many patients fail to attain the low levels of low-density lipoproteins (LDL) recommended in these guidelines, supplemental therapy, such as the addition of ezetimibe, bempedoic acid or PCSK9 inhibitors, is often required to reach LDL goals. As a result, the upfront use of combination therapies, particularly a statin plus ezetimibe, is a rational initial approach. The addition to statins of drugs that specifically lower triglyceride levels has not proven beneficial, although the addition of icosapent-ethyl has been shown to be of value, likely by mechanisms independent of triglyceride lowering. Newer treatments in development, including apoC-III and ANGPTL3 inhibitors, seem promising in further reducing apoB-containing lipoproteins.
- MeSH
- anticholesteremika terapeutické užití MeSH
- ateroskleróza farmakoterapie krev prevence a kontrola MeSH
- biologické markery krev MeSH
- diabetes mellitus 1. typu farmakoterapie diagnóza krev komplikace MeSH
- dyslipidemie * farmakoterapie krev diagnóza MeSH
- ezetimib terapeutické užití MeSH
- hypolipidemika terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- statiny terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Stanovení glukózy je zásadní pro diagnostiku a léčbu diabetu. Kromě laboratorního stanovení glykemie máme v současné době celou řadu možností, jak monitorovat hladinu glukózy zejména v domácím prostředí pacienta. Mezi tyto možnosti patří použití glukometrů, okamžité nebo kontinuální monitorace pomocí senzorů. Pacienti tak mají možnost provádět velmi efektivně selfmonitoring a aktivně se podílet na kompenzaci diabetu. V současné době jsou dle českých i mezinárodních doporučení glukózové senzory indikovány u všech osob s diabetem 1. typu. U určité skupiny jsou pak dále indikovány inzulinové pumpy, přičemž v kombinaci se senzory a algoritmem (tzv. hybridní pumpy), vedou k dalšímu zlepšení kompenzace. Všechny tyto technologie jsou v České republice dostupné, standardně se využívají a jsou hrazeny z prostředků veřejného zdravotního pojištění.
Glucose determination is essential for the diagnosis and treatment of diabetes. In addition to laboratory blood glucose testing, there is currently a variety of options available for monitoring glucose levels, especially in the patient's home environment. These options include the use of glucometers and intermittent or continuous monitoring using sensors. Patients thus have the opportunity to perform highly effective self-monitoring and actively participate in diabetes management. According to Czech and international recommendations, glucose sensors are currently indicated for all individuals with type 1 diabetes. Insulin pumps are further indicated for a specific group, and when combined with sensors and algorithms - known as hybrid pumps - they lead to further improvement in glucose control. All of these technologies are available in the Czech Republic, commonly utilized, and covered by public healthcare funding.
- MeSH
- diabetes mellitus 1. typu * diagnóza krev prevence a kontrola MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- selfmonitoring glykemie * přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Increased oxidative stress appears to be a risk factor for insulin resistance, dyslipidemia, β-cell dysfunction, impaired glucose tolerance, and, eventually, diabetes mellitus. The majority of research shows that oxidative stress plays a role in the etiology of diabetes through changes in enzymatic systems, lipid peroxidation, decreased levels of vitamin C, and reduced glutathione metabolism. Objectives: the study was conducted to evaluate biomarkers of oxidative stress such as serum malondialdehyde (MDA), myeloperoxidase (MPO), catalase (CAT), vitamins (C, E), nitric oxide (NO), reduced glutathione (GSH) levels and a lipid profile in newly diagnosed type I diabetics (IDDM). Methods: Patients are selected by simple randomization after professional diagnosis based on clinical examination and laboratory tests in a case-control study. This study included 24 newly diagnosed type I diabetics and 20 as a control group. Results: Newly diagnosed IDDM patients showed significantly higher MDA, MPO, TC, LDL, TC, TG, and AIP than the control group. The diabetic group also showed a significant decrease in CAT, GSH, HDL, NO and vitamins (E and C) when compared to healthy subjects. Conclusion: This study demonstrated that patients with type 1 diabetes have a disturbance in oxidant/antioxidant status and lipid profile.
Dovoluji si představit kazuistiku, ze které by byl nadšený snad každý diabetolog ve své praxi. Po první návštěvě ne úplně uspokojivě kompenzovaného pacienta máme pocit, že je naše práce úplně marná a čeká nás mnoho mravenčí práce a přesvědčování. Odměnou je následně pohled na pacienta po několika návštěvách, kdy vidíme výrazné zlepšení v kompenzaci, a před námi sedí pacient, který je spokojený sám se sebou, spolupracuje a je aktivní při terapii a kontrole diabetu. V ten okamžik si vždy uvědomím, že v ambulanci nesedím úplně zbytečně a snad je moje práce užitečná, prospěšná, a to je ten správný náboj do dalších pracovních dnů.
I would like to introduce a case report that almost every diabetologist would be excited about in his practice. After the first visit of a patient who is not completely satisfactorily compen- sated, we feel that our work is completely futile and a lot of hard work awaits us. The reward is to see the patient after several visits, with a significant improvement in compensation, sat- isfied with himself, cooperating and active in therapy and diabetes control. At that moment, I always realize that I do not sit in the office completely in vain, and that perhaps my work is useful, beneficial, and that is the right charge for the next working days.
- Klíčová slova
- degludek,
- MeSH
- diabetes mellitus 1. typu * farmakoterapie krev MeSH
- dlouhodobě působící inzulin * farmakologie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza MeSH
- inzulin aspart farmakokinetika farmakologie terapeutické užití MeSH
- inzulin glargin farmakokinetika farmakologie terapeutické užití MeSH
- krátkodobě působící inzuliny MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- selfmonitoring glykemie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- Freestyle Libre 2,
- MeSH
- analýza dat MeSH
- diabetes mellitus 1. typu farmakoterapie krev prevence a kontrola MeSH
- inzulinové infuzní systémy klasifikace MeSH
- kontinuální monitorování glukózy * metody přístrojové vybavení MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
