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

In an asymptomatic population, we investigated the relationships between glycated haemoglobin (HbA1c) and cartilage T2 relaxation time at the knee joint level. Fourteen and 17 participants with high and normal levels of HbA1c were recruited, respectively. A blood sample was used to determine the HbA1c level. T2 relaxation time (T2) of the superficial and deep parts of the femoral cartilage in the anterior, central, and posterior topographical sites was calculated using magnetic resonance (1.5 T) images. Each participant completed a knee injury and osteoarthritis outcome score questionnaire (KOOS) and a series of biomechanical analyses while running at their self-selected speed. The group with a high level of HbA1c had a lower score of KOOS symptoms than the other group (P < 0.05). HbA1c was found to be negatively related to the KOOS symptoms score. The group with a high level of HbA1c had low T2 values in all of the investigated topographical sites of the knee femoral cartilage (P < 0.05 in all cases). T2 was negatively correlated with HbA1c levels in all investigated knee femoral cartilage regions. Our data suggest that the subjects with high levels of HbA1c were those with low knee joint symptoms and lower values of T2. These results indicate that HbA1c could be correlated with cartilage deterioration due to its ability to dehydrate collagen fibre, possibly acting as a risk factor for the development of osteoarthritis.

• MeSH
• artróza kolenních kloubů krev   patofyziologie   MeSH
• dospělí MeSH
• glykovaný hemoglobin * metabolismus   MeSH
• kloubní chrupavka * metabolismus   MeSH
• kolenní kloub * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIM: To determine whether people with type 1 diabetes (T1D) initiating glucose sensor monitoring experience greater improvements in HbA1c when provided with education on carbohydrate counting and flexible insulin dosing than those who do not receive nutrition education. MATERIALS AND METHODS: Our retrospective observational study included 329 people with T1D initiating glucose sensor monitoring between 2015 and 2021. The participants were divided into two groups: one group attended at least one structured educational session with a registered dietitian (n = 126), while the other group did not receive structured education (n = 203). After 12 months of glucose sensor initiation, we compared glycaemic outcomes and CGM metrics between the two groups. RESULTS: At glucose sensor initiation, both groups with and without education had similar HbA1c levels (7.64% [60.0 mmol/mol] vs. 7.66% [60.2 mmol/mol]). After twelve months, the education group demonstrated greater improvement in glycemic outcomes (HbA1c 7.17% [54.9mmol/mol] vs. 7.37% [57.1 mmol/mol], p < 0.05) and spent significantly more time in the target range than did the group without structured education (68.8% vs. 64.1%, p < 0.05). We observed an inverse correlation between the number of completed educational sessions and HbA1c after 12 months, as well as between the number of educational sessions and the change in HbA1c. CONCLUSIONS: People with T1D who initiated glucose sensor monitoring alongside nutrition education showed greater improvements in HbA1c and increased time spent in the target glucose range compared to individuals who did not receive structured education. TRAIL REGISTRATION: ClinicalTrials.gov identifier: NCT06264271.

• MeSH
• diabetes mellitus 1. typu * krev   MeSH
• dospělí MeSH
• glykovaný hemoglobin * analýza   metabolismus   MeSH
• hypoglykemika aplikace a dávkování   MeSH
• inzulin aplikace a dávkování   MeSH
• krevní glukóza * analýza   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• regulace glykemie MeSH
• retrospektivní studie MeSH
• selfmonitoring glykemie * MeSH
• vzdělávání pacientů jako téma * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

OBJECTIVE: This study examined the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SD score (SDS), and diabetes technology uptake in youth. RESEARCH DESIGN AND METHODS: Data were from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland, and U.S. [Colorado]), including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, nonsevere, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. RESULTS: The analysis included 9,269 individuals (54.8% males, mean age 9.0 years). DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After 1 year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared with nonsevere DKA (7.23%, P = 0.001) and no DKA groups (7.14, P < 0.001), and this difference persisted after 2 years (7.58% vs. 7.38% [P < 0.001] and vs. 7.32% [P < 0.001]). Higher BMI SDS was observed in both DKA groups compared with no DKA. The use of AID was associated with lower HbA1c levels compared with other treatment modalities and moderated differences between DKA groups after 2 years of follow-up (P = 0.072). CONCLUSIONS: Severe and nonsevere DKA at type 1 diabetes diagnosis were both associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.

• MeSH
• diabetes mellitus 1. typu * epidemiologie   komplikace   krev   MeSH
• diabetická ketoacidóza * epidemiologie   MeSH
• dítě MeSH
• glykovaný hemoglobin metabolismus   MeSH
• hypoglykemika terapeutické užití   MeSH
• inzulin terapeutické užití   MeSH
• inzulinové infuzní systémy MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• následné studie MeSH
• předškolní dítě MeSH
• registrace 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
• Geografické názvy
• Itálie MeSH
• Lucembursko MeSH
• Německo MeSH
• Nový Zéland MeSH
• Rakousko MeSH
• Slovinsko MeSH
• Švýcarsko MeSH

Riziko rozvoje diabetické nefropatie je přímo úměrné době trvání diabetu 1. typu, zásadní roli hraje metabolická kom- penzace onemocnění. Vrchol její incidence spadá do období 10–20 let po stanovení diagnózy základního onemocnění. Roční incidence rozvoje albuminurie je u pacientů s diabetes mellitus 1. typu 2–3 %. Roční incidence poklesu odhadované glomerulární filtrace pod 60 ml/min/1,73 m2 činí 2–4 % bez ohledu na typ diabetu. Dle starších studií z konce 80. let má jednotlivec s diabetes mellitus 1. typu (DMT1) 40% riziko rozvoje proteinurie během 40 let trvání diabetu. Dle novějších průřezových studií z několika národních registrů rozvine mikroalbuminurii 8 % diabetiků 1. typu s délkou trvání diabetu méně než 20 let a téměř 25 % při délce trvání diabetu nad 40 let. I přes použití moderních terapeutických postupů v léčbě diabetu se u signifikantního podílu osob s DMT1 vyskytnou renální komplikace ve smyslu albuminurie či poruchy glo- merulární filtrace po méně než 20 letech od stanovení diagnózy. Zachování funkce ledvin po manifestaci proteinurie, se také zlepšilo, ale zůstává mnohem horší než u osob s DMT1 a absencí albuminurie. Studií, které by se zabývaly rychlostí vzniku diabetického onemocnění ledvin od stanovení diagnózy diabetu, není v dostupné literatuře dostatek k detailnímu popisu oblasti.

The risk of developing diabetic nephropathy is directly proportional to the duration of type 1 diabetes, with metabolic control of the disease playing a crucial role. The peak incidence of diabetic nephropathy occurs between 10 and 20 years after the diagnosis of the underlying disease. The annual incidence of albuminuria development in patients with type 1 diabetes mellitus is 2-3%. The annual incidence of a decline in estimated glomerular filtration rate below 60 ml/min/1.73 m2 is 2-4 %, regardless of the type of diabetes. According to older studies from the late 1980s, an individual with type 1 diabetes mellitus (DMT1) has a 40% chance of developing proteinuria over 40 years of diabetes duration. More recent cross-sectional studies from several national registries indicate that 8 % of type 1 diabetics with a diabetes duration of less than 20 years develop microalbuminuria, and nearly 25 % do so after more than 40 years of diabetes. Despite the use of modern therapeutic approaches in diabetes treatment, a significant proportion of individuals with DMT1 develop renal complications in the form of albuminuria or impaired glomerular filtration within less than 20 years after diagnosis. Although the preservation of kidney function after the onset of proteinuria has also improved, it remains much worse compared to individuals with DMT1 without albuminuria. There is a lack of studies in the available literature that adequately describe the rate of development of diabetic kidney disease from the time of diabetes diagnosis.

• MeSH
• albuminurie diagnóza   MeSH
• diabetes mellitus 1. typu diagnóza   farmakoterapie   komplikace   MeSH
• diabetické nefropatie * diagnóza   prevence a kontrola   MeSH
• glykovaný hemoglobin analýza   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

The molecular basis of increased hemoglobin in Andean Aymara highlanders is unknown. We conducted an integrative analysis of whole-genome-sequencing and granulocytes transcriptomics from Aymara and Europeans in Bolivia to explore genetic basis of the Aymara high hemoglobin. Differentially expressed and spliced genes in Aymaras were associated with inflammatory and hypoxia-related pathways. We identified transcripts with 4th or 5th exon skipping of NFKB1 (AS-NFKB1), key part of NF-kB complex, and their splicing quantitative trait loci; these were increased in Aymaras. AS-NFKB1 transcripts correlated with both transcripts and protein levels of inflammatory and HIF-regulated genes, including hemoglobin. While overexpression of the AS-NFKB1 variant led to increased expression of inflammatory and HIF-targeted genes; under inflammatory stress, NF-kB protein translocation to the nucleus was attenuated, resulting in reduced expression of these genes. Our study reveals AS-NFKB1 splicing events correlating with increased hemoglobin in Aymara and their possible protective mechanisms against excessive inflammation.

• MeSH
• alternativní sestřih * genetika   MeSH
• dospělí MeSH
• exony genetika   MeSH
• faktor 1 indukovatelný hypoxií - podjednotka alfa genetika   metabolismus   MeSH
• granulocyty metabolismus   MeSH
• hemoglobiny * metabolismus   genetika   MeSH
• lidé MeSH
• lokus kvantitativního znaku MeSH
• NF-kappa B - podjednotka p50 * metabolismus   genetika   MeSH
• regulace genové exprese MeSH
• transkriptom MeSH
• zánět * genetika   metabolismus   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Bolívie MeSH

BACKGROUND: The present study aimed to investigate the prognostic and predictive roles of Hb/RDW ratio in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI). MATERIALS AND METHODS: We performed a sub-analysis of a multicenter retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations. RESULTS: Three hundred and twenty-nine patients were enrolled, 244 males and 85 females. Median age was 65.5 years. The prognostic impact of the Hb/RDW ratio on PFS and OS was observed in the whole population examined. Hb/RDW ratio had a correlation with neutrophil-to-lymphocyte ratio (NLR), a blood inflammatory parameter. CONCLUSION: Hb/RDW ratio is a new inflammatory prognostic factor, easy to use in daily clinical practice.

• MeSH
• dospělí MeSH
• erytrocytární znaky MeSH
• hemoglobiny * analýza   metabolismus   MeSH
• imunoterapie * metody   MeSH
• inhibitory kontrolních bodů terapeutické užití   MeSH
• karcinom z renálních buněk * farmakoterapie   terapie   krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin * farmakoterapie   terapie   krev   patologie   mortalita   imunologie   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

PURPOSE: Obesity and its related severe comorbidities are increasing rapidly. The duodenal-jejunal bypass is an endoscopically implanted device (mimicking the Roux-en-Y gastric bypass) developed to support weight reduction and improve type 2 diabetes control. MATERIALS AND METHODS: Retrospective data analysis of consecutive patients undergoing duodenal-jejunal bypass (EndoBarrier®, DJB) implantation between 2013 and 2017 was performed to evaluate safety as well as short- and long-term efficacy. RESULTS: One hundred and twenty-one patients (mean BMI of 43.1 ± 7.2 kg/m2 and weight of 138.2 ± 28.6 kg) underwent DJB implantation. The mean dwelling time was 15.5 months, the mean total body weight loss (%TBWL) after explantation was 10.3% ± 7.9% (14.2 kg, p < 0.0001), and the mean BMI was 39.5 ± 7.3 kg/m2 (p < 0.0001). There was no significant weight gain 24 months after the explantation. Seventy-seven patients had type 2 diabetes mellitus (T2DM) with a mean HbA1c before implantation of 5.6% (n = 52). The mean HbA1c after explantation was 5.1% (p = 0.0001). Significant reductions in transaminase and lipid levels before and after explantation were observed. One complication occurred during implantation and another during explantation. In 16 patients, the device had to be extracted earlier than expected (7 for severe adverse events and 9 for adverse events; 13.2%). CONCLUSION: Despite an evident rate of adverse events, the DJB shows promise as a weight-loss procedure. Our results show that some patients implanted with the device maintained reduced weight even 24 months after explantation, while many improved T2DM control.

• MeSH
• diabetes mellitus 2. typu * chirurgie   komplikace   MeSH
• duodenum chirurgie   MeSH
• glykovaný hemoglobin MeSH
• hmotnostní úbytek MeSH
• jejunum chirurgie   MeSH
• lidé MeSH
• morbidní obezita * chirurgie   MeSH
• obezita chirurgie   komplikace   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• žaludeční bypass * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• agonisté receptoru pro glukagonu podobný peptid 1 * farmakologie   terapeutické užití   MeSH
• diabetes mellitus 2. typu * farmakoterapie   MeSH
• glykovaný hemoglobin účinky léků   MeSH
• hmotnostní úbytek MeSH
• hypoglykemika farmakologie   terapeutické užití   MeSH
• lidé MeSH
• obezita MeSH
• retrospektivní studie MeSH
• trvání terapie MeSH
• Check Tag
• lidé MeSH

• MeSH
• agonisté receptoru pro glukagonu podobný peptid 1 farmakologie   terapeutické užití   MeSH
• diabetes mellitus 2. typu * farmakoterapie   MeSH
• glykovaný hemoglobin účinky léků   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• pioglitazon farmakologie   terapeutické užití   MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• komentáře MeSH
• souhrny MeSH