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
This randomized trial tested the effect of metformin on glycemic control and cardiac function in patients with heart failure (HF) and type 2 diabetes while evaluating intestinal effects on selected gut microbiome products reflected by trimethylamine-N-oxide (TMAO) and gut-derived incretins. Metformin treatment improved glycemic control and postprandial metabolism and enhanced postprandial glucagon-like peptide 1 (GLP-1) secretion but did not influence cardiac function or the TMAO levels. Metabolic effects of metformin in HF may be mediated by an improvement in intestinal endocrine function and enhanced secretion of the gut-derived incretin GLP-1.
- Publication type
- Journal Article MeSH
1. vydání 211 stran : barevné ilustrace ; 24 cm
Příručka, která se zaměřuje na život s diabetem mellitus a na techniky jeho zvládání, včetně mnoha receptů. Určeno široké veřejnosti.; Cukrovka pod kontrolou je praktický průvodce životem s nemocí, která v Česku postihuje přes 750 tisíc lidí. Autorka Monika Němečková spojuje vlastní zkušenosti diabetičky se znalostmi nutriční terapeutky. Kniha radí, jak zvládat sport, cestování či výkyvy glykémie. První část vysvětluje principy diabetu včetně nízkosacharidové stravy, druhá přináší recepty pro stabilní hladinu cukru v krvi. Je určena všem, kteří chtějí žít s touto nemocí naplno.
- MeSH
- Diabetes Mellitus * MeSH
- Diet, Diabetic MeSH
- Disease Management MeSH
- Diet, Protein-Restricted MeSH
- Glycemic Control MeSH
- Healthy Lifestyle MeSH
- Publication type
- Cookbook MeSH
- Handbook MeSH
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- nutriční terapie, dietoterapie a výživa
- diabetologie
- zdravotní výchova
Inhibítory sodíko-glukózového kotransportéra 2 (SGLT2i), resp. gliflozíny, sú modernou a preferovanou skupinou antidiabetických liekov v liečbe pacientov s diabetes mellitus 2. typu. Liečba gliflozínmi sa spája s dobrou glykemickou kontrolou, nízkym rizikom hypoglykémie a poklesom telesnej hmotnosti s priaznivou protizápalovou remodeláciou tukového tkaniva, ako aj s významným kardioprotektívnym a nefroprotektívnym benefitom. Klinické randomizované štúdie s dapagliflozínom potvrdili jeho priaznivý vplyv na redukciu hospitalizácií pre srdcové zlyhávanie a mortalitu pacientov. Liečba sa spája so znížením progresie zlyhávania obličiek. Kardio-renálny benefit na srdcové zlyhávanie a prevenciu progresie chronickej choroby obličiek sa potvrdil aj u nediabetických pacientov. Podľa medzinárodných štandardov sa gliflozíny odporúčajú ako lieky prvej voľby u pacientov s diabetes mellitus 2. typu s vysokým kardiovaskulárnym rizikom.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors, gliflozins are a modern and preferred class of diabetic medications in the treatment of patients with type 2 diabetes mellitus. Treatment with gliflozins is associated with good glycemic control, low risk of hypoglycemia and weight loss with benefit anti-inflammatory remodelling of adipose tissue as soon as with important cardioprotective and nephroprotective benefit. Reduction of hospitalizations due to heart failure and mortality of patients was confirmed in clinical randomized studies with dapagliflozin. Treatment is associated with decreased progression of chronic kidney disease. Cardio-renal benefit on heart failure and prevention of progression on chronic kidney disease was confirmed also in non-diabetic patients. According to international standards gliflozins are recommended as first choice in treatment of patients with type 2 diabetes and high cardiovascular risk.
- Keywords
- dapagliflozin, nefroprotektivní účinek,
- MeSH
- Diabetes Mellitus, Type 2 drug therapy MeSH
- Sodium-Glucose Transporter 2 Inhibitors * pharmacology therapeutic use MeSH
- Cardio-Renal Syndrome drug therapy MeSH
- Cardiovascular Diseases prevention & control MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Chorea * etiology MeSH
- Dyskinesias etiology MeSH
- Glycated Hemoglobin analysis drug effects MeSH
- Hyperglycemia diagnosis complications therapy MeSH
- Humans MeSH
- Basal Ganglia Diseases * diagnosis etiology therapy MeSH
- Neuroimaging methods MeSH
- Glycemic Control methods MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Background: Type 2 diabetes is a common condition that causes the level of sugar (glucose) in the blood to become too high. It can cause symptoms relative insulin deficit, whether due to beta-cell damage, insulin resistance. The study of carnitine and LDH levels in diabetic patients is significant because both play important roles in the metabolism of glucose and fatty acids. Carnitine is a compound that transports fatty acids into the mitochondria for energy production, while LDH (lactate dehydrogenase) is an enzyme involved in the conversion of glucose to lactate. Humans with type 2 diabetes develop lipid accumulation due to carnitine depletion. LDH is an essential physiological molecule in the glycolytic pathway, and its concentration may be indicative of the condition of cellular metabolism.Aim: For measuring and evaluating the levels of serum carnitine and LDH in all study groups.Method: A case-control study was done in the Al-Zahraa Teaching Hospital, Kut, Iraq on 150 Iraqi males and females as patients and control between (April 2022 and January 2023). Their ages ranged between 44 and 77 years. Among them were 120 patients divided into 4 groups 30 type 2 diabetes mellitus; 30 diabetic cardiomyopathies; 30 diabetic nephropathies; 30 diabetic retinopathies and 30 control group where control group's age and gender matched those of the patient groups. All patients gave written informed consent to participate in the clinical study. ELISA was used to measure carnitine and LDH.Result: In present study, it was confirmed that carnitine was significantly lower than the control group and that LDH was significantly higher than the control group. the study demonstrated significant differences in fasting blood sugar and HbA1C levels among the control group, DM2, DCM, DNP, and DRP groups.Conclusion: This case-control study revealed significant differences in carnitine levels, LDH, FBS, and HbA1C levels among patients with Type 2 diabetes mellitus (T2DM) and their complications compared to the control group. These findings suggest alterations in energy metabolism and cellular damage in patients, indicating poorer glycemic control, and supporting the presence of uncontrolled diabetes.
- MeSH
- Diabetes Mellitus, Type 2 * diagnosis complications blood MeSH
- Adult MeSH
- Energy Metabolism physiology MeSH
- Carnitine * blood MeSH
- Diabetes Complications diagnosis classification blood MeSH
- Blood Glucose metabolism MeSH
- Lactate Dehydrogenases * blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Fatty Acids metabolism MeSH
- Aged MeSH
- Case-Control Studies MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Geographicals
- Iraq MeSH
BACKGROUND: Effective diabetes management requires a multimodal approach involving lifestyle changes, pharmacological treatment, and continuous patient education. Self-management demands can be overwhelming for patients, leading to lowered motivation, poor adherence, and compromised therapeutic outcomes. In this context, digital health apps are emerging as vital tools to provide personalized support and enhance diabetes management and clinical outcomes. OBJECTIVE: This study evaluated the impact of the digital health application Vitadio on glycemic control in patients with type 2 diabetes mellitus (T2DM). Secondary objectives included evaluating its effects on cardiometabolic parameters (weight, BMI, waist circumference, blood pressure, and heart rate) and self-reported measures of diabetes distress and self-management. METHODS: In this 6-month, 2-arm, multicenter, unblinded randomized controlled trial, patients aged 18 years or older diagnosed with T2DM were randomly assigned (1:1) to an intervention group (IG) receiving standard diabetes care reinforced by the digital health app Vitadio or to a control group (CG) provided solely with standard diabetes care. Vitadio provided a mobile-based self-management support tool featuring educational modules, motivational messages, peer support, personalized goal setting, and health monitoring. The personal consultant was available in the app to provide technical support for app-related issues. The primary outcome, assessed in the intention-to-treat population, was a change in glycated hemoglobin (HbA1c) levels at 6 months. Secondary outcomes included changes in cardiometabolic measures and self-reported outcomes. Data were collected in 2 study centers: diabetologist practice in Dessau-Roßlau and the University of Dresden. RESULTS: Between November 2022 and June 2023, a total of 276 patients were screened for eligibility, with 149 randomized to in intervention group (IG; n=73) and a control group (CG; n=76). The majority of participants were male (91/149, 61%). The dropout rate at month 6 was 19% (121/149). While both groups achieved significant HbA1c reduction at 6 months (IG: mean -0.8, SD 0.9%, P<.001; CG: mean -0.3, SD 0.7%, P=.001), the primary confirmatory analysis revealed statistically significant advantage of the IG (adjusted mean difference: -0.53%, SD 0.15, 95% CI -0.24 to -0.82; P<.001; effect size [Cohen d]=0.67, 95% CI 0.33-1). Significant between-group differences in favor of the IG were also observed for weight loss (P=.002), BMI (P=.001) and systolic blood pressure (P<.03). In addition, Vitadio users experienced greater reduction in diabetes-related distress (P<.03) and obtained more pronounced improvements in self-care practices in the areas of general diet (P<.001), specific diet (P<.03), and exercise (P<.03). CONCLUSIONS: This trial provides evidence for the superior efficacy of Vitadio in lowering the HbA1c levels in T2DM patients compared to standard care. In addition, Vitadio contributed to improvements in cardiometabolic health, reduced diabetes-related distress, and enhanced self-management, highlighting its potential as an accessible digital tool for comprehensive diabetes management. TRIAL REGISTRATION: German Clinical Trials Registry DRKS00027405; https://drks.de/search/de/trial/DRKS00027405.
- MeSH
- Diabetes Mellitus, Type 2 * blood therapy MeSH
- Adult MeSH
- Glycated Hemoglobin analysis MeSH
- Middle Aged MeSH
- Humans MeSH
- Mobile Applications * MeSH
- Self Care MeSH
- Self-Management MeSH
- Aged MeSH
- Telemedicine MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
The aim of this study was to test the hypothesis that individuals with an increase in HbA1c (i.e. above the regular but below the diabetic threshold) exhibit an impairment in the Achilles tendon structure and walking capacity, due to the adverse effect of the advanced glycation end-product. One hundred fifty-eight participants matched for gender, age, physical activity and BMI, were divided in two cohorts based on the HbA1c level: normal HbA1c (NGH; <39 mmol/molHb; n = 79) and altered HbA1c (AGH; >=39 mmol/molHb; n = 79). Each participant performed several walking trials to evaluate the kinematic parameters during walling at the self-selected speed and a quantitative MRI scan of the Achilles tendon (AT) to obtain its intrinsic characteristics (i.e. T2* relaxation time short and long component). The AT T2* relaxation time short component (a parameter related to the tendon collagen quality) was reduced in AGH compared to NGH. Furthermore, AGH exhibited a slower self-selected walking speed (NGH: 1.59 ± 0.18 m/s; AGH:1.54 ± 0.16 m/s) and a shorter stride length (NGH: 1.59 ± 0.13 m; AGH:1.55 ± 0.11 m). Our data suggest that a non-pathological increase in HbA1c is able to negatively affect AT collagen quality and walking capacity in healthy people. These results highlight the importance of glycemic control, even below the pathological threshold. Since diabetes could alter several biological pathways, further studies are necessary to determine which mechanisms and their timing, regarding the HbA1c rise, affect tendon composition and, consequently, walking capacity.
- MeSH
- Achilles Tendon * diagnostic imaging physiology metabolism MeSH
- Biomechanical Phenomena MeSH
- Walking * physiology MeSH
- Diabetes Mellitus diagnosis MeSH
- Adult MeSH
- Glycated Hemoglobin * metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Glycation End Products, Advanced metabolism MeSH
- Healthy Volunteers MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Automatické systémy pro dávkování inzulinu (AID) představují významný pokrok v léčbě diabetu, zejména pro pacienty s diabetem 1. typu (DM1T). Tyto uzavřené hybridní smyčky integrují technologii kontinuální monitorace glukózy (CGM) s léčbou inzulinovou pumpou (CSII). Napodobují fyziologickou funkci slinivky tím, že upravují dávku inzulinu v reakci na hladiny glukózy v reálném čase. Vývoj těchto systémů představuje zásadní milník v péči o diabetes a nabízí naději ke zlepšení kompenzace diabetu, snížení rizika hypoglykemie a zvýšení kvality života pacientů.
Automatic insulin delivery systems represent a significant advancement in the management of diabetes, particularly for individuals with type 1 diabetes. These systems, often referred to as hybrid closed-loop systems, integrate continuous glucose monitoring (CGM) technology with insulin pump therapy, aiming to imitate the physiological function of the pancreas by adjusting insulin delivery in response to real-time glucose levels. The development of these systems has been a critical milestone in diabetes care, offering the promise of improved glucose control, reduced risk of hypoglycemia, and enhanced quality of life for patients.
Diabetes mellitus (DM) je jedním z výrazně progredujících chronických onemocnění s vysokou celosvětovou prevalencí. Nehledě na typ diabetu je hlavním cílem zdravotnického týmu efektivní kompenzace metabolických abnormalit s cílem zabránit rozvoji pozdních komplikací či zpomalit jejich progresi do stádií výrazně snižujících kvalitu pacientova života. V posledních letech začíná stoupat počet odborných publikací podporujících domněnku, že stabilizace glykemie může mít zdravotní benefity i u zdravých nediabetiků. Tato práce sledovala vliv složení stravy (glykemické nálože) na glykemický profil a subjektivní parametry u mladých zdravých dobrovolníků pomocí kontinuální monitorace glykemie. Dospěli jsme k závěru, že ačkoliv subjektivní dotazníkové hodnocení ukazuje vyšší pocit útlumu po jídle nebo zhoršení dermatologických problémů ve skupině s vyšší glykemickou náloží, objektivní parametry kontinuální glykemické monitorace neukazují žádné významné rozdíly mezi skupinami podle glykemické nálože stravy. Závěrem můžeme předpokládat výraznou kompenzační schopnost regulačních systémů, které udrží glykemii v optimálním rozmezí i při vysoko-glykemické dietě.
Diabetes mellitus (DM) is one of the significantly progressive chronic diseases with high global prevalence. Regardless of the type of diabetes, the primary goal of the healthcare team is the effective management of the patient’s condition. In recent years, the number of scientific publications supporting the assertion that glycemic stabilization can have health benefits even for healthy non-diabetics has been increasing. In this study, we monitored the effect of diet composition (glycemic load) on the glycemic profile and subjective parameters in young healthy non-diabetic patients. We considered the significance of continuous monitoring on the health status of the participants. We concluded that while subjective questionnaire assessments show a higher feeling of postprandial lethargy and worsening of dermatological issues in the group with a higher glycemic load, the objective parameters of continuous glucose monitoring do not indicate any significant differences between the groups based on the glycemic load of their diet. In conclusion, we can assume a significant compensatory ability of regulatory systems to maintain glycemia within an optimal range even with a high-glycemic diet.
- MeSH
- Diet, Carbohydrate-Restricted MeSH
- Adult MeSH
- Clinical Studies as Topic MeSH
- Blood Glucose analysis MeSH
- Humans MeSH
- Young Adult MeSH
- Surveys and Questionnaires MeSH
- Glycemic Control * MeSH
- Diet, Carbohydrate Loading MeSH
- Blood Glucose Self-Monitoring MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
